Get Health Assessment Record (blue Form) - Bridgeport Board Of ... - Danbury K12 Ct

Filling out the Health Assessment Record (Blue Form) is an essential step to ensure your child receives proper health support at school. This guide provides a clear, detailed walkthrough of the form's sections and fields, allowing for a complete and accurate submission.

Follow the steps to successfully complete your Health Assessment Record online.

1. Press the ‘Get Form’ button to obtain the Health Assessment Record and open it in your document editor.
2. Begin by accurately filling in the student’s information at the top of the form. Include the student’s name (last, first, middle) and birth date.
3. Indicate the student's gender by checking the appropriate box (Male or Female). Next, provide the parent or guardian's name and contact information, including home phone and cell phone numbers.
4. Specify the school and grade your child is in. Then, indicate the child's race/ethnicity by selecting the applicable option from the listed categories.
5. Complete the fields related to health insurance by providing the name and number of the health insurance company, or Medicaid information if applicable. Answer whether the child has health and dental insurance.
6. In Part I, answer all health history questions regarding your child's health concerns, allergies, medications, and any issues related to vision, hearing, or speech. Circle 'Y' for yes or 'N' for no as applicable, and explain any 'Y' responses in the provided space.
7. Continue with the family history section, indicating any relatives who have experienced health issues as per the questions provided.
8. Review and complete the medical evaluation section which is to be filled by a health care provider. This includes detailing physical examination results and any necessary screenings.
9. Ensure that required immunizations are documented and that any chronic disease assessments are adequately filled out, including providing information on any ongoing health conditions.
10. Lastly, read the consent section carefully, and if you agree, sign and date the form in the designated areas.
11. Once all information is completed, save your changes, then download, print, or share the form as needed to ensure submission to the appropriate school health office.

Take the necessary steps to complete your Health Assessment Record online today to support your child's health needs at school.