504.14 Health Records
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Minidoka County Joint School District504.14 Health Records
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Minidoka County Joint School DistrictPOLICY TITLE: Health Records POLICY NO:
504.14
Minidoka County Joint School District # 331 PAGE 1 of 2
The Student's health record is designed to bring together all pertinent information regarding the
student's health. It should contain significant facts on his/her past history, results of teacher
observations, evaluations, and results of the findings of medical and dental health examinations.
Provisions:
The following provisions are intended to be used for compliance with this policy:
1. The teacher is responsible for recording observations and comments, when indicated, in
the space provided on the health record.
2. The records should help the teacher and others to better understand students and their
health problems.
3. The school health record will follow the student as part of the cumulative folder if he/she
transfers to another school or school system.
4. The records should be treated as confidential documents. The information should not be
released to others without written consent of the parents/guardian.
See attached form: “Authorization to Release Medical Information”
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LEGAL REFERENCE: Idaho Code §33-512(4)
ADOPTED: Original Adoption Date Unknown
RATIFIED: September 18, 2006
AMENDED/REVISED: Medical Release Form Added May 21, 2007
SECTION 500: STUDENT INDEX
HEALTH RECORDS—continued Page 2 of 2
Minidoka County School District #331
“Schools and Families Working Together”
Authorization to Release Medical Information
Patient/Student Name: __________________________________
I, , authorize the release of medical records to
Minidoka County School District from: _____________________________________________.
The information to be released should include:
( ) Medical Diagnosis
( ) History and Physical
( ) Recent Office visits
( ) Lab Reports
( ) Complete Medical Record (to exclude nothing)
( ) Other_________________________________
The purpose for obtaining these medical records is to facilitate treatment/nursing education at
school.
I understand that I may revoke this consent at any time except to the extent that action
has already been taken in reliance hereon, and if not revoked sooner in writing, this
consent will expire ONE YEAR from the date below or ______________________________,
at my election.
______________________________________ __________________
Patient/Parent/Guardian/Legal Representative Date
______________________________________ __________________
Witness (By Other than a Family Member) Date
Shanna Legault, RN
c/o Special Services (436-6059)
310 10th Street
Rupert, ID 83350
Laurie Stimpson
c/o Special Services (436-6059)
310 10th Street
Rupert, Idaho 83350