Transfer Student Health Record Summary
Student Information
Full Name
Date of Birth
Gender
Student ID
Grade
Previous School
Health History
Medical Conditions
Allergies
Medications
Physical Disabilities
Immunizations
DPT
Oral Polio
MMR
Hepatitis B
Varicella
Other Vaccines
Screening Results
Vision
Hearing
Scoliosis
Dental
Other Screenings
Additional Notes
Date Completed
Health Staff Name