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Ct health assessment form 2023-2025

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The document is a Health Assessment Record from the State of Connecticut Department of Education, designed to collect essential health information about students from their parents or guardians. It outlines the requirements for immunizations and health assessments mandated by state law prior to school entry and during specific grade levels. The form includes sections for personal details, health history, and medical evaluations, ensuring that school personnel are informed of each child's health needs to provide appropriate educational support.

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Click ‘Get Form’ to open the ct health assessment form 2023 in the editor.
Begin by filling out Part I, which requires information from the parent or guardian. Enter the student’s name, birth date, and gender. Ensure you provide your contact details and the school/grade information.
Complete the race/ethnicity section by selecting the appropriate options. Then, indicate whether your child has health insurance and provide relevant details if applicable.
Answer all health history questions by circling 'Y' for yes or 'N' for no. Be sure to explain any 'yes' answers in the provided space to give a comprehensive overview of your child's health.
In Part II, ensure that a qualified healthcare provider completes and signs the medical evaluation section after conducting a physical examination. This includes documenting vital statistics like height, weight, and blood pressure.

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Versions	Form popularity	Fillable & printable
2012	4.9 Satisfied (394 Votes)
2010	4.4 Satisfied (51 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are health assessment forms?

While both types of health services serve different purposes, they complement each other in a way that helps improve your overall health. While yearly wellness visits can help assess your health risks, your doctor cant physically check for anything wrong.

Can I get a copy of my immunization records online CT?

The CT WiZ Public Portal allows individuals who were vaccinated in Connecticut to access their own immunization records, while parents and guardians can also access their minor childs records.

What is a health assessment form?

The health assessment is a survey about an individuals health history, current environment, and lifestyle. This information may be given to your doctor so that you and your doctor can develop a plan of care that meets your needs.

How do I opt out of CT WiZ?

By Mail or Fax: Send us a letter requesting to opt out of CT WiZ and include the full legal name, date of birth, and address of yourself or your child (under age 18).