SCHOOLBASED HEALTH CENTER HEALTH VISIT REPORT FORM Well child exam only (see attached physical exam form) SBHC Name and - mmcp dhmh maryland 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the SBHC Name & Address, followed by the SBHC Provider Number and Contact Information. This section is crucial for identifying the health center.
3. Fill in the MCO Name & Address along with contact details. Ensure accuracy as this information is vital for communication.
4. Input student details including Name, DOB, MA Number, and SS Number. These identifiers are essential for record-keeping.
5. Document the Date of Visit and Type of Visit (Acute/Urgent, Follow Up, Health Maintenance) to categorize the purpose of the appointment.
6. Complete the provider's information including Name/Title and vital signs (T, P, RR, BP). This data is important for assessing patient health.
7. Fill out sections on Hgt, Wgt, BMI, and other clinical findings such as ICD-10 Codes and CPT Codes to ensure comprehensive documentation.
8. Review and finalize all entries before saving or sharing your completed form using our platform’s features.

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