AGENCY: Department of Health and Human Services. Office of Children with Special Healthcare Needs

SERIES: 82282
TITLE: Family history questionnaire file
DATES: 1986-
ARRANGEMENT: Chronological

DESCRIPTION: This is a questionnaire sent to families in which a newborn child has been identified as a high risk for hearing loss. It is used to identify cases where an individual has been incorrectly identified as being at risk. The form includes parent's and child's name, and a history of family members who have had hearing losses.

RETENTION

Retain for 6 month(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 06/1988

FORMAT MANAGEMENT

Paper: Retain in Office for 6 months and then destroy.

APPRAISAL

Administrative

After the questionnaire is completed and individuals not at risk are identified, the record has only administrative value. After six months, that value ends.

PRIMARY DESIGNATION

Private

---