Family Doctor definition

Family Doctor. Name: Address: Phone: Are your child’s immunisation records up to date? ◼ Yes ◼ No (please provide a copy for file) If my child is unwell I will arrange for my child to be collected from the centre, within an hour of being contacted. I understand that my child cannot attend the centre if they are sick/infectious.

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Family Doctor. Doctor’s Phone: Medical Concerns to be Shared with Coaches: NOTE: ALL STUDENTS TRYING OUT/PRACTICING FOR A SPORT MUST HAVE A CURRENT PHYSICAL EXAM ON FILE WITH THE SCHOOL NURSE. A CURRENT PHYSICAL EXAM IS ONE THAT HAS BEEN COMPLETED WITHIN TWELVE MONTHS OF THE LAST DAY OF THE SEASON. PHYSICALS ARE VALID FOR ONE CALENDAR YEAR. o o Is your student covered under a school insurance policy? Yes No If not, your signature constitutes a waiver and a confirmation of other insurance coverage: Insurance Company: Policy Number:

Family Doctor. Phone: Hospital: Known Allergies: Alternate Emergency Contact Name(s): Relationship: Phone(s): OR SPECIAL EDUCATION NEEDS DISCLOSURE (Required at time of registration): ** If student is served at their school as a Special Ed student, the most current IEP must be filed in the DTC Office prior to course start date in order for student to be served. Please, Do Not withhold this information, as it means the success and safety of your child.

Examples of Family Doctor in a sentence

• The Clinic will work in good faith with the RHA’s Primary Care Connector to accept patients who have requested a primary care provider through the provincial Family Doctor Connection Program.

• Emergency Contact Phone Number ( ) Medical Insurance Policy Number Member’s Name Phone Number ( ) Family Doctor Phone Number ( ) In the event of an emergency, the undersigned hereby give(s) permission to be transported to a hospital.

• Medication my child is taking at present: Family Health Plan carrier number: Family Doctor: Phone Number: As Parent or Guardian, I agree to all of the above stated considerations and conditions.

• Family Doctor Phone Family Dentist Phone Family Health Plan Carrier Policy Number I also agree to provide the Pastor, the designated Youth Ministry representatives, Chaperon or adult volunteer with current telephone numbers at which I can be reached, as well as the names and phone numbers of individuals who are likely to know where I am should an emergency arise.

• The Employer will also provide medical and surgical benefits including Family Doctor Plan, anesthesia coverage and such additional benefits as provided by the expanded Group Health Insurance Plan, including rider "C”.

• Signature of Parent or Guardian Family Doctor Phone Hospital Preference Our School Nurse program is staffed by nurses from Community Health Network and will provide limited services to all students, including but not limited to - screening for signs of illness, first aid/emergency care, referral to health providers in the community, nutrition services, health education, health screenings and immunization information.

• In the event of any emergency, if you are unable to reach me at the above numbers, contact Name/Relation Emergency Phone Number Medication my child is taking at present: Family Health Plan carrier number: Family Doctor: Phone Number: As Parent or Guardian, I agree to all of the above stated considerations and conditions.

• Family Doctor: __ Phone: I prefer the hospital for emergency treatment.

• Name Birth Date Grade Gender Student’s Current School Parent's (Guardian) Name Address Cell or Home Phone Parent's daytime phone number Parent’s Email If parents cannot be contacted notify Phone Family Doctor Dr. Phone Known Allergies Insurance Carrier If student is not insured, parent assumes all medical responsibilities.

• The RHA Clinic physicians and staff will work in good faith with the RHA’s Primary Care Connector to accept patients who have requested a primary care provider through the provincial Family Doctor Finder.

More Definitions of Family Doctor

Family Doctor means being registered and in good standing with the College of Physicians and Surgeons of Ontario to conduct a practice in Family Medicine;

Family Doctor. Last Name: First Name: Address: Phone: City: State: Zip Code:

Family Doctor. Phone: • Family Dentist: Phone: • Medical Insurance: , , (ID Number) (Group Number) (Member’s Name) • Medical History: Allergies, if any, including medication and foods: • Chronic or existing diseases or medical problems (e.g. diabetes, epilepsy): • Medicines now being taken and dosage: • Date of last Tetanus injection or booster (if known): • Any physical restrictions: I, (we) can be reached at the following phone numbers(s) in an emergency: ,( ) (Name and Location) (Phone) ,( ) (Name and Location) (Phone) (Signature(s) of Parent(s)/Legal Guardian(s)) (Date) (Signature of Prospective Student) (Date) We are excited to meet you and hope that after spending a few days with us, you begin to see what it means to be a part of the Notre Dame family. As a Catholic university, Notre Dame has a distinct mission – focused on developing the whole person. Our policies and procedures are intended to contribute to the moral, intellectual, spiritual and social growth of the individuals and groups that constitute this community. As our guests for the weekend, we trust that you will respect all of the policies as outlined by du Lac: A Guide to Student Life, particularly: All students and guests are responsible for complying with University regulations and Indiana laws regarding possession or consumption of alcohol. Any person under 21 years of age is underage in the State of Indiana. All students and guests are expected to comply with Indiana law at all times. Students and guests may be subject to disciplinary action for underage consumption, possession or transportation of alcoholic beverages. In order to make the weekend as productive as possible and for the safety of all those participating, we ask that you: