Health Assessment Record (Blue Form) - Bridgeport Board of ... - danbury k12 ct 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the student's name, birth date, and gender. Ensure accuracy as this information is crucial for identification.
  3. Fill in the parent/guardian's name and contact details, including home and cell phone numbers. This ensures that the school can reach you if necessary.
  4. Complete the race/ethnicity section by selecting the appropriate options. This data may be used for demographic purposes.
  5. Answer all health history questions in Part I by circling 'Y' for yes or 'N' for no. Provide explanations for any 'yes' answers in the designated space.
  6. In Part II, ensure that a healthcare provider completes and signs the medical evaluation section after conducting a physical examination.
  7. Review all entries for completeness and accuracy before saving or printing your document.

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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.
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.
A school health assessment is a systematic collection, review, and analysis of information about school health-related policies and programs for the purpose of improving students health and educational outcomes.

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