Recommended Data Elements for School Health Forms

The purpose of these resources is to support pediatric health professionals who are looking to advocate for the critical data elements in the school health form for school health professionals to effectively care for children while they are in school.

Background: The American Academy of Pediatrics (AAP) Council on School Health (COSH) has received numerous requests to create a universal school health form. However, there are challenges with creating a single form to be used across all school districts in the US, including the wide range of regulatory reporting requirements. In addition, more and more pediatricians are using electronic health records (EHR) to document the care they are providing. Reflecting on these factors, the COSH determined that the best course forward was to make recommendations on what components and data elements should be considered as part of a school health form. These recommendations take into account that these measures should be reportable fields in most standard EHRs and should decrease the need for customization. The COSH also would recommend that school districts build the ability to receive the information transmitted electronically. In addition, school districts should accept the data in other formats besides the pre-approved school format.

Below, the COSH has broken down the major categories of information and what should be reported in each area.

Demographics

• Student Name (discrete fields for Last Name, First Name, Middle Initial)
• Date of Birth
• Gender (Female, Male, non-binary or another gender)
• Guardian Name (discrete fields for Last Name, First Name, Middle Initial) [multiple parents possible]
• Relationship to Child
• Home Address
• Preferred Phone Number
• PCP Name
• PCP Address
• PCP Phone

The COSH does not recommend using the school health form to report on the school name or grade of the student. The pediatrician is not the most accurate reporter on these elements, and that data should already be readily available to the school. The COSH does not recommend including reporting of insurance by the primary care provider to avoid any concerns about privacy for the family. There are other mechanisms for the school to gain access to this information.

Medical History

• Problem List (active problems)
• Medication Allergies
• Food Allergies
• Other allergies
• Medications (name of medication)

Many school districts include specific reporting requirements for asthma, anaphylaxis, diabetes and seizures. The COSH suggests that any of these should be part of an active, up-to-date problem list, which should not include sensitive or administrative information. If there is a specific action plan, the school health form should not be the mechanism to collect this information, and it should be done in a separate format. Careful consideration about disclosure of any sensitive information should be given and confirmed with the student/family with particular attention to mental health diagnoses and medications.

Physical

• Date of Exam
• Height
• Weight
• Body Mass Index and Percentile
• Blood Pressure

The COSH does not recommend reporting additional visit-specific vital signs. The variability of these items is high and has little relevance for future assessments. Some jurisdictions require Tanner Stage to assess the ability of the student to play sports at a higher or lower grade level. However, the COSH believes these exceptions should be addressed individually instead of in a standardized health form.

Immunization Record

The COSH supports including this report as part of the school health form. Any medical exemptions should be noted.

Screenings

• Except for anemia and lead results, all screenings should be pass/fail; Need date of all screenings
• Vision
• Hearing
• TB (Screening with testing only as indicated by screening results)
• Anemia and Lead (Particularly as required for Head Start programs)
• Age-appropriate developmental screening (Particularly as required for Head Start programs)

The COSH strongly believes that primary care providers should be completing the recommended developmental and scoliosis screenings. However, the results of those screenings will be reported in the problem list instead of a separately reported screening on the school health form. This also accounts for how this information would be captured in most EMRs.

Sports Clearance

• Cleared for All sports without restrictions Y/N

The COSH supports reporting of sports clearance on the school health form as recommended by the AAP Council on Sports Medicine and Fitness. However, there is variability in EMRs regarding whether this clearance is part of the annual physical. The COSH believes the advantage of including it in the EMR is it will decrease the administrative burdens for primary care providers who would have to complete a separate sports clearance form for many patients if it is not included. If unable to participate without restrictions, COSH recommends using another mechanism to document what type of participation is permissible.

Recommendations/Accommodations

Schools need a mechanism to know if a child or adolescent requires specific treatments or accommodations to succeed in school. The COSH recommends that this be accomplished outside the school health form. As previously mentioned, any condition-specific action plan (such as asthma, diabetes, seizures or anaphylaxis) would be completed separately from this form. The same holds true for any academic or behavioral accommodations required in school.

Signature

The school health form needs a mechanism to have an electronic signature to ensure sign-off by the provider and the date signed.