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State of Connecticut Reportable Disease Confidential Case Report Form PD23 (rev. 01/01/2013)Department of Public Health 410 Capitol Avenue, MS×11FDS P.O. Box 340308 Hartford, CT 061340308For information
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01
Obtain the necessary forms and documents needed to fill out the school based health center application.
02
Fill out the personal information section, including your name, date of birth, address, and contact information.
03
Provide details about your medical history, including any chronic illnesses, allergies, or medications you are currently taking.
04
Fill out the consent forms, ensuring that your parents or guardians sign if you are a minor.
05
Indicate your preferred primary care provider, if applicable.
06
Provide emergency contact information.
07
Review and double-check all the information you have provided to ensure accuracy and completeness.
08
Submit the completed application to the designated school staff or health center personnel.
09
Follow up with the school or health center to inquire about the status of your application.

Who needs school based health center?

01
School based health centers can benefit various individuals, including:
02
- Students who require routine health check-ups and vaccinations.
03
- Students with chronic illnesses or medical conditions that require ongoing care and monitoring.
04
- Students who do not have easy access to off-campus medical facilities.
05
- Students who are unable to afford healthcare services or lack health insurance.
06
- Students who need mental health counseling or support.
07
- Students who require emergency medical assistance during school hours.
08
- Students who need preventive care and health education.
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A school based health center is a facility that provides a range of health services to students within a school setting.
School administrators and health professionals who operate or oversee a school based health center are required to file.
To fill out a school based health center form, you will need to provide detailed information about the services offered, patient demographics, and outcomes.
The purpose of a school based health center is to improve access to healthcare services for students, promote wellness, and support academic success.
Information such as the number of patients seen, types of services provided, demographics of patients, and health outcomes must be reported.
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