Get the free School-Based Clinic Program Referral from School Staff - henry mpls k12 mn

Department of Health and Family Support Schooled Clinic Program Referral from School Staff Date From: To: School Nurse Teacher School Social Worker Counselor Assistant Principal Special Ed. Other

How to fill out school-based clinic program referral

How to Fill Out a School-Based Clinic Program Referral:

1. Start by obtaining a referral form from the school-based clinic or healthcare provider. This may be available online or in person at the clinic.
2. On the referral form, provide your personal information, including your name, date of birth, address, and contact details. These details are vital for identification and communication purposes.
3. Indicate the reason for your referral. Specify the medical condition or concern that requires attention from the school-based clinic program. Be as clear and specific as possible so that the healthcare provider can address your needs accurately.
4. If applicable, include any relevant medical history. This could include previous diagnoses, medications, allergies, or ongoing treatments that may impact the care provided by the school-based clinic program.
5. If you have a preferred healthcare provider within the school-based clinic program, mention it on the referral form. This will ensure that you are directed to the appropriate healthcare professional who can meet your specific needs.
6. If there are any additional instructions or requests that you would like the healthcare provider to consider, write them down on the referral form. This could include any accommodations, preferences, or concerns you may have regarding your medical care.

Who Needs a School-Based Clinic Program Referral:

1. Students who require medical attention or evaluation during school hours can benefit from a school-based clinic program referral. This could include both physical and mental health concerns.
2. Parents or guardians may need to seek a referral for their child if they have a medical condition that necessitates ongoing care or monitoring during school hours. The referral ensures that the school-based clinic program is aware of the student's healthcare needs and can provide appropriate support.
3. Students who require specific health services, such as vaccinations, routine check-ups, or management of chronic conditions, may require a referral to access the school-based clinic program.

In conclusion, filling out a school-based clinic program referral involves providing personal information, specifying the reason for the referral, sharing relevant medical history, indicating preferred healthcare providers, and including any additional instructions. Students who require medical attention or ongoing care during school hours may need a school-based clinic program referral.

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What is school-based clinic program referral?

School-based clinic program referral is a process where students are referred to a clinic located within the school for medical services and interventions.

Who is required to file school-based clinic program referral?

School administrators, teachers, and healthcare providers are required to file school-based clinic program referral forms.

How to fill out school-based clinic program referral?

To fill out a school-based clinic program referral, one must provide basic information about the student, reason for referral, and consent for medical services.

What is the purpose of school-based clinic program referral?

The purpose of school-based clinic program referral is to provide convenient access to medical services for students while at school.

What information must be reported on school-based clinic program referral?

Information such as student's name, school ID, reason for referral, medical history, and contact information must be reported on school-based clinic program referral.