New Jersey Department of Education

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Keeping Our Kids Safe, Healthy & In School

Student Health Records

Health History and Appraisal (A-45)

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    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.