STUDENT HEALTH CARD

Name: [Student's Full Name]

Date of Birth: [Date of Birth (DD/MM/YYYY)]
Gender: [Male/Female/Other]
Grade/Class: [Grade/Class]
School: [School Name]
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Emergency Contact Information:
Name: [Emergency Contact Name]
Relationship: [Relationship to Student]
Phone: [Emergency Contact Phone Number]
Address: [Emergency Contact Address]
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Blood Type: [Blood Type]
Weight: [Weight (in kg)]
Height: [Height (in cm)]
BMI:

Medical Conditions:
[Medical Condition 1]
[Medical Condition 2]
[Medical Condition 3]
[Medical Condition 4]
[Medical Condition 5]

Allergies:
[Allergy 1]
[Allergy 2]
[Allergy 3]

Medications:
[Medication 1]
[Medication 2]
[Medication 3]

Vaccination History:
[Vaccine 1]
[Vaccine 2]
[Vaccine 3]

Any Disabilities -
Any Deformities -
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Vision: [Vision Information]

Hearing: [Hearing Information]
Dental: [Dental Information]
Parents Signature ---------------------------