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RETURN KEEP THIS HOSTAGE PAGEWelcome to the Program20182019 School Year Effective: August 1, 2018Dear Parent/ GuardianWelcome to the Dr. Robert E. Appleby School Based Health Centers, a program of
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Fill out required personal information such as name, address, date of birth, and contact information.
02
Provide information about any pre-existing medical conditions or allergies.
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List any current medications being taken.
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Indicate any specific medical concerns or reasons for visiting the school based health center.
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Sign and date the form to confirm consent for receiving medical services at the school based health center.

Who needs school based health centershsc?

01
Students who require access to basic healthcare services while at school.
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Students who may not have easy access to healthcare outside of school hours.
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Students who need assistance with managing chronic medical conditions while at school.
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Students who require preventive healthcare services such as vaccinations or screenings.
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Students who may be in need of mental health or counseling services.
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School based health centers (SBHCs) are medical facilities located within or in close proximity to schools.
School administrators or designated healthcare providers are typically responsible for filing school based health centershsc.
To fill out school based health centershsc, one must gather relevant medical information and demographic data of students who utilize the health center.
The purpose of school based health centershsc is to provide accessible healthcare services to students, improve health outcomes, and support academic achievement.
Information reported on school based health centershsc typically includes number of student visits, types of services provided, and student demographics.
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