Specific Medical Information Clause Samples
Specific Medical Information. The Parish will take reasonable care to see that the following information will be held in confidence. Chronic Conditions (e.g. Epilepsy; Diabetes) Allergic Reactions (e.g. Food, medications, plants, etc.) Dietary Restrictions Immunizations: Date of last tetanus/diphtheria immunization: Any physical limitations? Has the Participant recently been exposed to contagious disease or conditions, such as mumps, measles, chicken pox, etc.? If so, list date and disease or condition: You should be aware of these special medical conditions of the Participant:
Specific Medical Information. The parish or school will take reasonable care to see that the following information will be held in confidence.
Specific Medical Information. Transfiguration Catholic Church will take reasonable care to see that the following information will be held in confidence.
Specific Medical Information. The parish/school will take reasonable care to see that the following information will be held in confidence. You should be aware of these special medical conditions of my child:
Specific Medical Information. Church of Immaculate Conception and all Churches participating, will take reasonable care to see that the following information will be held in confidence. Allergic reactions (medications, foods, plants, insects, etc.): Immunizations-Date of last tetanus/diphtheria immunization: Does child have a medically prescribed diet? Any physical limitations? Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chickenpox, etc.? If so, date and disease or condition: Any special medical conditions?
Specific Medical Information. The School will take reasonable care to see that the following information will be held in confidence.
Specific Medical Information. If the Consenting Patient does not wish to authorize an indiscriminate release of all his or her medical information through this instrument of consent, he or she may limit the authorized release of medical information to only a specific topic or condition. For this effect, select the second checkbox statement from the Second Article. Additionally, this selection requires that the exact nature of the information the Patient authorizes for release is established on the blank space available.
Specific Medical Information. The Parish will take reasonable care to see that the following information will be held in confidence. Chronic Conditions (e.g. Epilepsy; Diabetes) Allergic Reactions (e.g. Food, medications, plants, etc.) Dietary Restrictions Immunizations: Date of last tetanus/diphtheria immunization: Any physical limitations?
Specific Medical Information. The Parish will take reasonable care to see that the following information will be held in confidence. Has the Participant recently been exposed to contagious disease or conditions, such as mumps, measles, chicken pox, etc.? If so, list date and disease or condition: You should be aware of these special medical conditions of the Participant: