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