AGENCY: Central Utah Public Health Department (Utah)
SERIES: 9987
TITLE: Preschool screening patient charts
DATES: 1965-1970.
ARRANGEMENT: Alphabetical by patient name
DESCRIPTION: These charts record results of medical examinations given to school children in Millard County. Typical files contain (1) a report of clinic examination, (2) checklist for readiness, (3) evaluation clinic control sheet, and (4) questionnaire for school health examination/consent form.
Recorded information on the report of clinic examination includes the patient's name, address, county, location of clinic, date of clinic, birth date, name of family physician, name of county director, the name of the examining physician, and the physician's report and recommendations.
The checklist for readiness asks questions concerning development of the child in four categories: social, physical, language, and work habits.
The evaluation clinic control sheet records the clinic location and date, the names of the child and the child's parents, address, weight, height, vision of both eyes, results of lab tests, speech, hearing, pediatric screening, pediatric examination, psychology screening, social wo rk, special education, nurses, staff conference, volunteers, the time spent during each phase of the examination, and the total time spent examining each individual.
The health examination questionnaire/consent form includes the child's name, address, height, weight, sex, name of regular physician, number of moves in the last three years, date and place of birth, number of brothers and sisters, personal and family health histories, and a parent's signature authorizing the examination of the child.
RETENTION
DISPOSITION
RETENTION AND DISPOSITION AUTHORIZATION
Retention and disposition for this series were specifically approved by the State Records Committee.
APPROVED: 10/2003
FORMAT MANAGEMENT
Paper: Retain in Office for 3 years and then transfer to State Records Center. Retain in State Records Center for 4 years and then destroy.
APPRAISAL
Administrative Legal
This disposition is based on the records administrative needs expressed by the agency and reflects all pertinent statute of limitations provisions.
PRIMARY DESIGNATION
Private