Oregon School Health Screening Record Page 3
ADVERTISEMENT
1
2
3
4Guidelines for Recording on Oregon School Health Screening Record
[Form 581-3417 (11/10)
Demographic Information
Contents of Health Screening Record
Only the results of health screenings shall be recorded/stored in this Health
Name and Student Number: Use pen or type
Screening Record. Other health information shall be kept separately from
Space is provided for a demographics label; re-label as necessary
health screening information to protect confidentiality. Contents:
Health Alert: Check box if student has a health condition which may
Certificate of Immunization Status (CIS) form
affect him/her during the school day
Tuberculosis Clearance Certificate, if the child has one
Health Management Plan: Check box if student has a health
Records of medications given the child in the school setting, if
condition which is serious enough to require an individualized
related to the IEP
Health Management Plan. Note location of the health plan
A current copy of the Health Management Plan
Records of first aid health room visits and the instructions sent to the
Screening Results
parent, according to district policy
Follow screening procedures in manual, Health Services for the School
Communications related to health and safety and directed to
Community. Screening comments should address results of screening. Other
information should be documented in the medical/nursing file to preserve
the school from the parent or health care provider
confidentiality of health information.
Record date by month/year
Archival Data
Vision: Record results of vision screening. Document rechecks under
Retain the following with the education record for three years after
―Additional Screening Results‖; check if the student is wearing
graduation:
corrective lenses
Certificate of Immunization Status (CIS) form
Hearing, Scoliosis, Dental: Use provided code
Tuberculosis Clearance Certificate
Height: Record to the nearest one-fourth inch
Retain the following with the special education record for seven years after
Weight: Record to the nearest one-half pound
graduation:
Blood Pressure: Note arm on which blood pressure was taken
Health Management Plan, if it is an addendum to the IEP
Height and weight charts are included in the manual
Medication record, if medication administration is addressed in the
TB Clearance Certificate—See back of Health Screening Record for
IEP
list of birth countries which necessitate a clearance certificate
Certificate of Immunization Status (CIS)—See back of Health
Transfer of Records
Screening Record for directions
Transfer the following with the educational record:
Certificate of Immunization Status (CIS) form
Tuberculosis Clearance Certificate
Health plan, if related to the IEP
Medication records, if related to the IEP
Uncleared exclusion orders for Immunization/Tuberculosis
Transfer the following with the educational record if it is significant in
maintaining the child safely in the school setting:
Communications from parents and health care providers
directed to the school
Records of first aid provided and instructions given to the parent
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal