HEALTH QUESTIONS Sample Clauses

HEALTH QUESTIONS. Has the Primary Insured:

HEALTH QUESTIONS. Has any proposed Insured:

HEALTH QUESTIONS. (NOTE: The Technician, if applying for Group Term Life, Disability Income or Supplemental Disability Income, within 31 days of employment does not have to complete this section. If applying for these coverages after 31 days of employment or applying for Supplemental Term (coverage over $50,000), Technician must answer these health questions. Spouse must always answer the health questions when applying for coverage. In Minnesota, the applicant does not have to disclose an HIV (AIDS Virus) test which was administered: (1) to a criminal offender or crime victim as a result of a crime that was reported to the police; (2) to a patient who received the services of emergency medical services personnel at a hospital or medical care facility; (3) to emergency medical personnel who were tested as a result of performing emergency medical services. Refer to the Authorization and Acknowledgement section for a definition of "Emergency Medical Personnel". Technician Spouse A. Have you had medical attention, consulted a physician or been hospitalized in the last 5 years? ❑ Yes ❑ No ❑ Yes ❑ No B. At the present time are you under a doctor's care or taking medication for any condition? ❑ Yes ❑ No ❑ Yes ❑ No C. In the last five years have you been diagnosed or treated by a physician for any of the following? ❑ Yes ❑ No ❑ Yes ❑ No Circle each specific condition: Lung disorder, high blood pressure, heart trouble, nervous disorder, ulcer, liver or stomach disorder, kidney or urinary disorder, diabetes, arthritis, back trouble, cancer, eye or ear impairment, any female disorder, or any physical defect or deformity? For each "Yes" answer, give details below: (If necessary, please attach additional sheet signed and date by Technician and Spouse if applying). Nature of illness, injury or treatment Person to whom it applies Date of treatment Physician's name and address

HEALTH QUESTIONS. Please fill in the following by writing either YES or NO: Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity? Do you frequently have pains in your chest when you perform physical activity? Have you had chest pain when you were not doing physical activity? Do you lose your balance due to dizziness or do you ever lose consciousness? Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anaemia, epilepsy, respiratory ailments, back problems, prior head injury, unusual susceptibility to injury, pregnancy, etc.)? Are you pregnant now or have given birth within the last 6 months? Have you had a recent surgery? If yes, would the surgery affect your ability to undertake anything offered by Corporate Fitness Centre? Do you take any medications, either prescription or non-prescription, on a regular basis?