AGENCY: Department of Health. Bureau of Chronic Disease Control

SERIES: 6636
TITLE: Diabetes control program enrollment form
DATES: i 1981-1986.
ARRANGEMENT: Alphabetical by county

DESCRIPTION: This is the diabetes control program enrollment form which includes a consent for the release of medical information. Included in these records are age, current and past addresses, birth date, medical information, name, occupation, religious preference, sex, signature, telephone number, the date diabetes was discovered, who else in the family has diabetes, the type of care taken for the diabetes, the name of the family physician, the names of other physicians, a record of hospital stays for the last five years, and the areas where the client would like additional help.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then transfer to State Records Center. Retain in State Records Center for 4 years and then destroy.

APPRAISAL

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