Student Health Records
- A-45 Health Card
The Health History and Appraisal form (A-45) was revised in August 2016 to add Interferon-Gamma Release Assay (IGRA) to the "TB Screening" section, as recommended by the New Jersey Department of Health. Since this revision to the A-45 was only a slight modification, districts may continue to use their current supply of A-45 forms created prior to this revision and record the IGRA results in the TB Screening box labeled as "IGRA Result," if applicable. When the current supply is depleted, districts must use the new A-45 form.
The A-45 was last revised in June 2014 to add concussion and traumatic brain injury (school nurses are required to document if a student has a diagnosed concussion/TBI) and in June 2012 to accommodate school districts that have chosen to measure students' Body Mass Index (BMI). It is at the discretion of the school nurse to enter BMI on the form or leave it blank, since it is currently not a required health screening in New Jersey.
Pursuant to N.J.A.C. 8:57-4.6, all immunization records submitted by a parent or guardian in a language other than English are required to be accompanied by a translation sufficient to determine compliance with the immunization requirements.
The NJDOH has provided additional guidance and stated that any person can translate a foreign immunization record as long as compliance with New Jersey’s immunization requirements can be determined. The NJDOH does not require the translation to come from a healthcare provider, however, all translations must include the printed name and signature of the translator. Additionally, the Center for Disease Control (CDC) provides a resource to assist with deciphering foreign vaccines. The New Jersey Department of Education has created a resource list of Translation Services by County . This is a new resource.
- Student Athlete Forms
- Annual Athletic Pre-Participation Physical Examination Form
- Health History Update Questionnaire
- NJ Family Care Memo - Emergency Card and Electronic Transmission of Student Information
- NJ Family Care Sample Emergency Card
- Medical Privacy – Applicability of HIPAA to Health Information in the Schools
- New Jersey Division of Archives & Records Management
Provides information regarding records management.
The following regulations can be found on the NJDOE Administrative Code page.
- N.J.A.C. 6A:16-2.4, Required student health records
- N.J.A.C. 6A:32-7, Student Records