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Position H511.340 (Rev. 4/00)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTHSCHOOL PERSONNEL HEALTH RECORD I. Patient Informational NameMlFirstSexSocial Security Cumbersome TelephoneMailing AddressStreetUsual
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How to fill out school personnel health record

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Step 1: Obtain a copy of the school personnel health record form from your school or district.
02
Step 2: Provide personal information, including your name, date of birth, and contact information.
03
Step 3: Fill out the medical history section, providing details about any pre-existing medical conditions, allergies, or medications you are currently taking.
04
Step 4: Provide information about your immunization history, including dates and types of vaccines received.
05
Step 5: Fill out the emergency contact information, including names, phone numbers, and relationships of individuals who should be contacted in case of an emergency.
06
Step 6: Sign and date the form, indicating that the information provided is accurate and complete.
07
Step 7: Submit the completed school personnel health record to the appropriate school or district office.
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Step 8: Keep a copy of the completed form for your records.

Who needs school personnel health record?

01
School personnel, including teachers, administrators, and support staff, need to fill out a school personnel health record. This is usually required by educational institutions to ensure the safety and well-being of both the employees and students. The information provided in the record helps in addressing any health-related issues that may arise within the school environment.
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The school personnel health record is a document that contains health information of the school staff, including their medical history, current health status, and any special health considerations.
All school personnel, including teachers, administrators, and support staff, are required to file a school personnel health record.
The school personnel health record can be filled out by the individual staff member with assistance from their healthcare provider, if necessary. It typically involves providing personal health information, immunization records, and emergency contact information.
The purpose of the school personnel health record is to ensure the health and safety of school staff, as well as to provide necessary information in case of emergencies or medical needs.
The school personnel health record typically includes personal information, medical history, immunization records, allergies, medications, emergency contacts, and any special health considerations.
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