Get Md School-based Health Center Health Visit Report Form 2015-2025

Filling out the MD School-Based Health Center Health Visit Report Form online is a straightforward process designed to ensure that all essential information related to a student's health visit is adequately captured. This guide will walk you through each section of the form, providing detailed instructions for efficient completion.

Follow the steps to fill out the health visit report form accurately.

1. Click ‘Get Form’ button to access the document and open it in your preferred online environment.
2. Begin by entering the name and address of the School-Based Health Center (SBHC) at the top of the form. Also, input the SBHC provider number, contact name, telephone number, and fax number. Ensure that all details are current and accurate.
3. Next, provide the details of the Managed Care Organization (MCO). Fill in the MCO name and address, along with the contact name, telephone number, and fax number. Record the date when the information was faxed, if applicable.
4. Proceed to fill out the student's information, including their full name, date of birth, MA number, and Social Security number. Verify that all information matches official records.
5. Document the date of the visit and specify the type of visit: Acute/Urgent, Follow Up, or Health Maintenance. Select the appropriate option based on the context of the visit.
6. Enter the provider’s name and title, followed by clinical measurements: temperature (T), pulse (P), respiratory rate (RR), blood pressure (BP), and O2 saturation (PaO2). These metrics are crucial for assessing the patient's current health state.
7. Record the student's height (Hgt), weight (Wgt), and body mass index (BMI) in the designated fields. Ensure that all measurements are precise and recorded correctly.
8. Indicate the student's age and provide any relevant Health and Present Illness (HPI) details. This section serves to highlight the patient’s health context and concerns.
9. List any applicable ICD-10 codes to classify the diagnoses accurately. This information is vital for proper record-keeping and insurance processing.
10. Fill out laboratory results, including rapid strep test results, hemoglobin (Hgb), blood glucose levels (BGL), and urinalysis (U/A) as needed.
11. Document any drug allergies, current medications, and the immunization review. Note if the immunizations are up-to-date (UTD), given today, or needs are required.
12. Record the chief complaint as stated by the patient and provide the past medical history. Indicate whether it is unremarkable, requires a health history review, or has pertinent details.
13. In the physical findings section, categorize your observations by system (general, cardiac, head, lungs, etc.). Provide details while using the 'pertinent' term where applicable.
14. Formulate an assessment based on the findings noted in the previous step. Clearly outline the plan, including any prescriptions, laboratory work, or radiology services ordered.
15. Sign the form and denote if a primary care provider (PCP) follow-up is required by selecting yes or no.
16. Once all sections are completed, you may save your changes, download the finished document, print, or share it as needed.

Start filling out your MD School-Based Health Center Health Visit Report Form online today to ensure accurate and timely documentation.