Get Dhmh School Based Health Center Visit Report Form

Filling out the Dhmh School Based Health Center Visit Report Form online is essential for documenting student health visits accurately. This guide will provide you with clear instructions for each section of the form to ensure all necessary information is captured effectively.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the SBHC name and address, along with the SBHC provider number, contact name, telephone, and fax number in the designated fields.
3. Next, enter the MCO name and address, contact name, telephone, and fax number as required. Also, indicate the date faxed.
4. Complete the student information section by providing the student's name, date of birth (DOB), Medicaid (MA) number, and social security (SS) number.
5. State the date of visit and select the type of visit from the options provided: Acute/Urgent, Follow Up, or Health Maintenance.
6. Document the provider's name and title, followed by the vital signs including temperature (T), pulse (P), respiratory rate (RR), blood pressure (BP), and pulse oximetry (PaO2).
7. Fill out the height (Hgt), weight (Wgt), and calculate the body mass index (BMI). Additionally, provide the age and history of present illness (HPI).
8. Record the chief complaint and past medical history. Additionally, include ICD-9 codes where applicable.
9. Document any rapid strep test results, hemoglobin (Hgb), blood glucose level (BGL), and urinalysis (U/A) indicators.
10. Indicate any drug allergies, current medications, and immunization review details, specifying if vaccinations are up to date or if any were given during the visit.
11. Provide pertinent physical findings for each section such as general appearance, cardiac, lungs, ears, abdomen, eyes, genitalia, extremities, mouth, neurologic, and neck findings.
12. Complete the assessment section and outline the plan by detailing any prescriptions, labs, or radiology services ordered.
13. Ensure to add your signature as the provider and indicate if primary care follow-up (PCP F/U) is required.
14. Once all fields are completed, you can save changes, download the form, print, or share it as needed.

Complete the Dhmh School Based Health Center Visit Report Form online today to ensure efficient and accurate health documentation.