Refugee Health Screening Form
Refugee Health Screening Form
Initial health screening intake for newly arrived refugees, used by public health departments to coordinate medical evaluation and referrals.
Client Demographics
Full legal name *
Your answer
Date of birth
Country of origin
Date of arrival in the United States
Alien Registration Number (A-Number)
Your answer
Resettlement agency
Your answer
Current address
+ 11 more questions
About this template
Initial health screening intake for newly arrived refugees, used by public health departments to coordinate medical evaluation and referrals.
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