Health History Questionnaire definition

Health History Questionnaire means a questionnaire completed by the Gestational Carrier and/or the Child’s biological father.
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Health History Questionnaire means a questionnaire about past or current health conditions.
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Health History Questionnaire. Immunization Records verification (including but not limited to MMR (Measles, Mumps, and Rubella), Varicella, Tetanus/T-dap, and the Hepatitis B series.  Influenza Vaccination: All students will be offered the influenza vaccine during flu season (early October – late March) and documentation will be kept to track the acceptance or declination of the vaccine. This can be done during the Colleague Tune-Up in October.
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Examples of Health History Questionnaire in a sentence

  • Health History Questionnaire – ALL QUESTIONS MUST BE ANSWERED OR THE APPLICATION MAY BE RETURNED AND/OR REJECTED.

  • Those who formally withdraw from the study will have their Health History Questionnaire immediately shredded and all images will be deleted from the USB drive.

  • Complete Interest Form, Health History Questionnaire, and Policies forms and either return or fax them to the Fitness Department at (401) 865-2426.

  • Health History Questionnaire (HHQ) Circle either a YES or NO response to each question.

  • As evidenced on the Health History Questionnaire, I have advised the staff of any and all medical conditions including but not limited to disease and/or injuries I may have and the use of any medications that may effect or limit my participation or use of any specific equipment or activity.

  • Physical ExaminationAs part of the entry requirements, students entering a Health Sciences program must receive a physical examination with the results documented on the CSN health sciences student Health History Questionnaire.

  • No member or non-member can conduct any type of business on MFC premises without the express permission of McCormack Fitness Center, Inc.• Prior to participation in activities at the MFC, a member must submit an accurate and complete Personal Information Form, Membership Agreement, Express Assumption of All Risks and Release of Liability Agreement, and a Health History Questionnaire (HHQ).

  • Please completely fill out the attached Demographic and Health History Questionnaire prior to your arrival for your first appointment.

  • Follow all health and safety guidelines, including submitting the Camp Health History Questionnaire before the first day of camp and those established due to the COVID-19 pandemic.

  • Specifically, when I compare the implementation of projects for which the corresponding representative is on the appropriate committee, I instrument for membership using individual relevant sectoral experience.


More Definitions of Health History Questionnaire

Health History Questionnaire means a form that is required to be completed by each person in the household, prior to enrollment that is submitted with the initial premium payment, that indicates any previously treated condition, or disease, or medication received by the person.
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Related to Health History Questionnaire

  • Investor Questionnaire has the meaning set forth in Section 5.8.

  • Questionnaire means the Documentation Information Questionnaire and the responses thereto provided by Borrowers and delivered to Agent.

  • Collateral Questionnaire means a certificate in form satisfactory to Collateral Agent that provides information with respect to the personal or mixed property of each Credit Party.

  • Accredited Investor Questionnaire means the Accredited Investor Questionnaire set forth as Exhibit C-1 hereto.

  • Notice and Questionnaire means a Notice of Registration Statement and Selling Securityholder Questionnaire substantially in the form of Exhibit A hereto.

  • Selling Shareholder Questionnaire shall have the meaning set forth in Section 3(a).

  • Selling Stockholder Questionnaire shall have the meaning set forth in Section 3(a).

  • Administrative Questionnaire means an Administrative Questionnaire in a form supplied by the Administrative Agent.

  • Exhibit F The awarded category pricing from the Contractor’s submitted Price Sheet from 3rd Bid RFP 15-80101507-SA-D

  • list of accredited prospective providers means the list of accredited prospective providers which the municipality must keep in terms of paragraph 14 of this policy;

  • Exhibit 2 Standard File Codes – Delinquency Reporting, Continued The FNMA Delinquent Reason Code field should show the Reason for Delinquency as follows: Delinquency Code Delinquency Description 001 FNMA-Death of principal mortgagor 002 FNMA-Illness of principal mortgagor 003 FNMA-Illness of mortgagor’s family member 004 FNMA-Death of mortgagor’s family member 005 FNMA-Marital difficulties 006 FNMA-Curtailment of income 007 FNMA-Excessive Obligation 008 FNMA-Abandonment of property 009 FNMA-Distant employee transfer 011 FNMA-Property problem 012 FNMA-Inability to sell property 013 FNMA-Inability to rent property 014 FNMA-Military Service 015 FNMA-Other 016 FNMA-Unemployment 017 FNMA-Business failure 019 FNMA-Casualty loss 022 FNMA-Energy environment costs 023 FNMA-Servicing problems 026 FNMA-Payment adjustment 027 FNMA-Payment dispute 029 FNMA-Transfer of ownership pending 030 FNMA-Fraud 031 FNMA-Unable to contact borrower INC FNMA-Incarceration

  • Appendix Information means the information which must be provided for the selected modules as set out in the Appendix of the Approved EU SCCs (other than the Parties), and which for this Addendum is set out in:

  • Exhibit C Form xx Xxxxx B-4, B-5 or B-6 Certificate.................... Exhibit D: (Resexxxx)................................................... Exhibit E: Form of Reverse of Certificates.............................. Exhibit F: Form of Initial Certification of Master Servicer............. Exhibit G: Form of Final Certification of Master Servicer...............

  • Health care information means any information, whether oral or recorded in any form or medium that identi- fies or can readily be associated with the identity of, and relates to the health care of, a patient or client.

  • Exhibit D means Exhibit D to the Judgment;

  • Exhibit E means Exhibit E to the Judgment;

  • Exhibit B means [Vendor]’s Response.

  • Urgent care request means a claim relating to an admission, availability of care, continued stay or health care service for which the covered person received emergency services but has not been discharged from a facility, or any Pre-Service Claim or concurrent care claim for medical care or treatment for which application of the time periods for making a regular external review determination:

  • Data Tape Information The information provided by the Responsible Parties as of the Cut-off Date to the Depositor or the Sponsor setting forth the following information with respect to each Mortgage Loan: (1) the Mortgagor's name; (2) as to each Mortgage Loan, the Scheduled Principal Balance as of the Cut-off Date; (3) the Mortgage Rate Cap; (4) the Index; (5) a code indicating whether the Mortgaged Property is owner occupied; (6) the type of Mortgaged Property; (7) the first date on which the Scheduled Payment was due on the Mortgage Loan and, if such date is not consistent with the Due Date currently in effect, such Due Date; (8) the "paid through date" based on payments received from the related Mortgagor; (9) the original principal amount of the Mortgage Loan; (10) with respect to Adjustable Rate Mortgage Loans, the Maximum Mortgage Rate; (11) the type of Mortgage Loan (i.e., Fixed Rate or Adjustable Rate Mortgage Loan, First Lien Mortgage Loan or Second Lien Mortgage Loan); (12) a code indicating the purpose of the loan (i.e., purchase, rate and term refinance, equity take out refinance); (13) a code indicating the documentation style (i.e., full, asset verification, income verification and no documentation); (14) the credit risk score (FICO score); (15) the loan credit grade classification (as described in the underwriting guidelines); (16) with respect to each Adjustable Rate Mortgage Loan, the Minimum Mortgage Rate; (17) the Mortgage Rate at origination; (18) with respect to each Adjustable Rate Mortgage Loan, the first Adjustment Date immediately following the Cut-off Date; (19) the value of the Mortgaged Property; (20) a code indicating the type of Prepayment Charges applicable to such Mortgage Loan (including any prepayment penalty term), if any; (21) with respect to each Adjustable Rate Mortgage Loan, the Periodic Mortgage Rate Cap; (22) the applicable Responsible Party with respect to such Mortgage Loan; (23) with respect to each First Lien Mortgage Loan, the LTV at origination, and with respect to each Second Lien Mortgage Loan, the CLTV at origination; and (24) if such Mortgage Loan is covered by a primary mortgage insurance policy or a lender-paid primary mortgage insurance policy, the primary mortgage insurance rate. With respect to the Mortgage Loans in the aggregate, the Data Tape Information shall set forth the following information, as of the Cut-off Date: (1) the number of Mortgage Loans; (2) the current aggregate outstanding principal balance of the Mortgage Loans; (3) the weighted average Mortgage Rate of the Mortgage Loans; and (4) the weighted average maturity of the Mortgage Loans.

  • Exhibit means any item labeled as an Exhibit in the Solicitation or placed in the Exhibits section of the solicitation.

  • Information Package means the most recent compilation of financial and other data with respect to the Failed Bank, including any amendments or supplements thereto, provided to the Assuming Institution by the Corporation on the web site used by the Corporation to market the Failed Bank to potential acquirers.

  • Exhibit One Mortgage Loan Schedule Exhibit Two: Schedule of Discount Fractions Exhibit Three: Information to be Included in Monthly Distribution Date Statement Exhibit Four: Standard Terms of Pooling and Servicing Agreement dated as of March 1, 2003 This is a Series Supplement, dated as of April 1, 2003 (the "Series Supplement"), to the Standard Terms of Pooling and Servicing Agreement, dated as of March 1, 2003 and attached as Exhibit Four hereto (the "Standard Terms" and, together with this Series Supplement, the "Pooling and Servicing Agreement" or "Agreement"), among RESIDENTIAL FUNDING MORTGAGE SECURITIES I, INC., as the company (together with its permitted successors and assigns, the "Company"), RESIDENTIAL FUNDING CORPORATION, as master servicer (together with its permitted successors and assigns, the "Master Servicer"), and BANK ONE, NATIONAL ASSOCIATION, as Trustee (together with its permitted successors and assigns, the "Trustee").

  • Verbal abuse means, but is not limited to, the use of derogatory terms or names, undue voice volume and rude comments, orders or responses to residents.

  • Disclosure Counsel means the Special Counsel designated by the Corporation to be responsible for the drafting and delivery of the Corporation’s disclosure documents such as preliminary official statements, official statements, re-offering memorandums or private placement memorandums and continuing disclosure agreements.

  • Functional Acknowledgement means an acknowledgement Message by the receiving party’s computer software application which automatically confirms the receipt of a Message at the moment of receipt;

  • MI Report means a report containing Management Information submitted to the Authority in accordance with Framework Schedule 8 (Management Information);