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Must be 10 digits. Currently Entered: 0 digits.
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Gender *
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Study Period at CUHK *
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GENERAL HEALTH INFORMATION
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Besides routine check-ups, have you been treated by a medical specialist, or seen a counselor in the past 12 months? *
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Are you currently on medications? *
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Are you ALLERGIC to any food/medications? *
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Do you smoke on a regular basis? *
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Do you consume alcohol on a regular basis? *
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MEDICAL HISTORY
Students with known and ongoing medical conditions should prepare for and manage their condition while on exchange.
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Have you ever been diagnosed with, treated for, or hospitalized for:
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Have you ever had surgery? *
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EMERGENCY CONTACT (PERSON TO BE NOTIFIED IN CASE OF EMERGENCY)
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I understand this is a legal representation of my signature.
Clear
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Contact the Office of Academic Links
Students who have any question about completing the confidential health history form are welcome to contact the Office of Academic Links by email: iasp@cuhk.edu.hk, or phone: (852) 3943 7597.
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The personal data collected will be used by Office of Academic Links (OAL) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.