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Revere Local Schools 3496 Everett Rd, Rich field, OH 44286Physicians Report *School Nurse must have on file within 30 days of starting school×School Student Attends:___ When completed, this form
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Gather all necessary personal information such as name, address, contact number, and insurance details.
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Complete medical history information including any pre-existing conditions or allergies.
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Fill out any specific health concerns or reasons for seeking health services at home.
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Who needs health services home?

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Individuals who are homebound due to illness or injury and are unable to travel to a healthcare facility.
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Elderly individuals who require regular medical attention but prefer the comfort and convenience of receiving care at home.
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Patients who have recently been discharged from the hospital and need continued monitoring and care in a home setting.
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Patients with chronic conditions or disabilities who require ongoing medical services but are unable to visit a healthcare facility.
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Health services home is a facility where health care services are provided to individuals in a residential setting.
Health services homes are typically required to be filed by the owner or operator of the facility.
Health services homes can be filled out by providing information about the facility, services offered, and any regulatory compliance.
The purpose of health services home is to ensure that individuals receive proper health care services in a residential setting.
Information such as facility name, location, services provided, and compliance with regulations must be reported on health services home.
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