Crafting Health History & Medical Clearance Forms

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How are confidential medical forms gathered?

Some international programs make it a policy to include a confidential health history and clearance form signed by a medical provider and/or an accommodation request form in the acceptance packet sent to each participant. These forms encourage the individual to talk with the medical provider about what is needed while on the program, and allows participants the option to disclose disability information and request accommodations they may require while abroad with the program staff.

Organizations should make it clear that disability information is kept confidential and is requested for the purpose of arranging accommodations or services.

Here’s some key guidelines to follow:

  • The same form should be given to ALL participants.
  • It should be connected with essential requirements of the overseas program.
  • It should be separate from and given after the application to encourage disclosure.
  • Usually the form is a requirement after selection when the participant is considered “conditionally accepted”.
  • The form cannot be significantly more laborious for those with mental health conditions or other disabled participants to complete.

One example of how a provider who offers programs in all parts of the world including very remote areas of Africa, Asia and Latin America might briefly explain essential requirements: "The type of program can vary – some include physically demanding components. All participants will be fully active in the culture. Many will live with a family for a protracted period of time in varying conditions of sanitation and proximity to Western-style health facilities and psychological services."

What message should the medical form be sending?

The form should explain that the information is needed so the program staff can:

  • Act safely and quickly in case of an emergency abroad,
  • Determine if the individual can meet essential requirements or needs a different or deferred program,
  • Arrange for in-country supports as needed,
  • Inform participants about conditions abroad related to accessibility or their medications, treatment or overall health.

 

What messages are participants looking for when reading the medical forms?

If I disclose a disability could I still be cleared to go (e.g. do I trust there’s not a blanket bias)?

Example: On a clearance form to be filled out by medical provider or psychiatrist it shows three ways with stipulations that someone can be cleared:

  1. If in opinion of practitioner, the condition is under control
  2. Have a treatment plan in place for abroad (if currently being treated)
  3. Have been stable on medications for a reasonable period.

How will my information be assessed (e.g. what do you mean by stable)?

Example: Definition of Stable: You must be in a state where any changes in symptoms are not foreseen or expected.

Example: Assessment of individual’s ability to meet essential requirements of the program includes these indicators of stability:

  1. Individual does not rely on counseling or medical care for daily functioning
  2. Stable on medications
  3. Length of time since inpatient or intensive outpatient treatment

Who will be seeing the medical information and how will it be kept confidential?

Example: This information will be kept confidential and will be provided to our in country director and program staff as necessary in case of an emergency.

Will I have input on if I can meet the essential requirements of program?

Example: A staff member may contact individual participants to discuss program realities and to clarify expectations for our program staff and for the student.

Will it help me if I disclose to find out about in-country resources and support (e.g. is it beneficial)?

Example: The form shares information about mailing or getting medications abroad for the participant to consider and talks about how there may be fewer local resources to help individual manage potential triggers abroad. It may mention how pre-existing conditions can be intensified by living in different culture and the need to anticipate how new environment and stresses abroad will impact health.

 
Sample medical history and accommodation request forms can be found on study abroad providers websites, such as SIT Study Abroad, Northwestern Univeristy Study Abroad and University of California System Education Abroad Programs health clearance forms and health history forms. See Related Links.