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Ct health assessment form

Health Assessment Record (Blue Form) - Bridgeport Board of ... - danbury k12 ct 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 necessary for school enrollment and participation in sports. The form includes sections for personal details, health history, and medical evaluations by healthcare providers, 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 it in the editor.
Begin by entering the student's name, birth date, and gender. Ensure accuracy as this information is crucial for identification.
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.
Complete the race/ethnicity section by selecting the appropriate options. This data may be used for demographic purposes.
Provide information about health insurance status. If applicable, include the health insurance company and number.
In Part I, answer all health history questions regarding your child’s medical background. Circle 'Y' for yes or 'N' for no, and provide explanations where necessary.
Once completed, review all entries for accuracy before submitting. Use our platform's features to save or print a copy for your records.

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What is the purpose of the health assessment?

Your GP will generally, Ask about your lifestyle ie: if you smoke, your weight, alcohol consumption. Ask about any medication you may be taking. Take your blood pressure. Order any blood tests, scans or other tests. Talk to you about your mental health. Answer any questions that you may have.

What is a health assessment form?

A community health assessment (CHA) refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection, and analysis.

Is a health assessment the same as a physical exam?

if your care provider wants to know if youre healthy, the physical assessment is only part of the job of finding out. lifestyle, diet, exercise, safety, living quarters, all sorts of things go into a health assessment.

What is an example of a health assessment?

Initial Health Assessment The health assessment should include, at a minimum, documentation of the patients health history, measuring vital signs (including height and weight), and a physical examination by a provider or registered nurse.