UPR003526-15 Manual 2942.0 SHSM Vol I DRAFT master

43 / 138

43
DoDEA School Health Services Manual 2942.0 Volume 1 Revised: 2016 DRAFT
D-3 School Health Records
D-3-1 Student Health History
The sponsor/parent/guardian will complete the DoDEA Student Health History
Form 2942.0-M-F1 (SHSM: H-1-1), upon initial registration for each dependent or a
DoDEA Returning Student Health History Update Form 2942.0-M-F2 (SHSM: H-1-2).
The sponsor/parent/guardian must also present at the time of initial registration a copy
of their dependent’s immunization record. (See Immunization
Screening, or other official copy of the immunization record.) Student health
information provided by the sponsor/parent/guardian shall be treated in a confidential
and professional manner according to the PA and kept in a locked filing cabinet in the
school health office. The information will be shared only with school personnel on a
need-to-know basis to ensure the safety and welfare of students. Documents related to
special education programs are not part of the student health record.
According to DoD AI 15, Volume II (Health Records Management), student
health records, immunization records, sponsor/parent/guardian permission forms,
screening results, sports physicals, primary care manager/provider referrals, and
medication consents are placed in the student cumulative record files (AI-15 file
numbers 1903-01 or 1904-01) upon graduation, withdrawal, transfer, or death of the
student and retained, consistently, with the retention schedule applicable to that file as
stated in AI-15. A summary report of the student’s health history may be generated
and hand-carried by a sponsor/parent/guardian to a new school or mailed to the school
with consent from the sponsor/parent/guardian authorizing release of the records to the
new school. The summary report should include student immunizations and may
include a list of medical alerts, health conditions, or medications taken during school
hours, if applicable. The summary report should never contain information
obtained and documented during individual office visits.
See (Protection of Student Health) for more information related to
student health information.
Reference:
DoD Administrative Instruction -15, May 3, 2013 available at:
D-3-2 Individual Health Care Plan and Emergency Action Plan