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U.S. Department of Health and Human Services
Indian Health Manual

Part 3, Chapter 13: Manual Exhibit III

Office of Indian Education Program (OIEP) Indian Health Service (IHS)
Procedures for Preparation and Transmittal of
Health Records of American Indian and Alaska Native Students


  1. Purpose
  2. Background
  3. Policy
  4. Procedures
  1. Purpose - To provide a description of those procedures and responsibilities required by the local IHS service units and BIA agencies that will assure that a student's complete health record is available to school health clinics at the time the student arrives at the boarding school.
  2. Background - It is important to the health of the boarding school student that complete health information including history, immunization status, physical examination, special treatment programs, and prohibited activities be known to school health personnel.
  3. Policy - OIEP and IHS staff will prepare and transmit complete health information for all students who are applying for boarding school placement according to the procedures as outlined.
  4. Procedures
    1. Responsibilities of OIEP Agency (l) or Tribal Education Office.
      1. A boarding school student applicant contacts an agency office or a tribal education office functioning under a P.L. 93-638 contract.
      2. It is the responsibility of the agency office or tribal office to request that the local IHS facility, as far in advance of the opening of school as possible, carry out the health appraisal of student applicants and complete these three health documents:
        1. Report of Medical Examination (HRSA-197; 3-74) - Items 1, 2, 4-8, and l0-18 are to be completed by the agency or tribal office.
        2. Immunization and Sensitivity Record (HRSA-216; 4-79).
        3. Consent of Parent or Legal Guardian or Other Person Who Has Primary Responsibility for the Care of the Child (HRSA-47; 4-8).
      3. The agency or tribal office will file completed applications for placement (including the three IHS documents) with the appropriate school 30 or more days before the opening of school.
      4. If any or all of the health documents are not available 30 days before the school opens, the incomplete application will be transmitted to the School at that time.  For practical purposes this means that the health documents must be received by the agency or tribal office no later than the first day of August, if the health information is to be included with the other documents.
      5. Authorization for student travel will not be provided until all the necessary health documents have been received and processed by the agency or tribal education office.
    2. Responsibilities of the Boarding School
      1. Routine School Admissions.  As soon as the three IHS health documents of an accepted student have been received by the school, the administrative staff will transmit them to the director of the school health clinic or designated person.
      2. Emergency School Placement
        1. Emergency school placement is the necessary placement of a student within 24-48 hours which prevents utilizing the normal forms processing procedure.
        2. Within two working days after an emergency school placement of a student, the school administrative office will transmit the following information to the director of the school health clinic.

          Name of Student
          Home address of Student
          Name of Student's home health facility

        3. It will then be the responsibility of the school health clinic to obtain the health documents and to carry out any necessary health appraisals.
    3. Responsibility of IHS Facilities
      1. Lines of communication are to be developed between the IHS facility and the OIEP Agency or tribal education office.
      2. Clinical services must be provided efficiently and rapidly, and forms processed in a timely fashion so that the student's application can be transmitted to the boarding school.
      3. The medical examination is to be recorded on the Report of Medical Examination (HRSA-197), which is to be kept in the patient's clinical chart.  On this form items 1, 2, 4-8, and l0-18 are to be completed by the Agency or tribal office and the remainder by the health provider or providers.  Item 39 pertains to item 38.  Items 27, 28, 29, 30, 31, 40, 41 and 42 are not required unless already known or specifically indicated.  Items 22, 23, 24 should be carried out by a dentist, and items 40 and 42, by an audiologist, audiometric technician or nurse.
      4. A student in need of immunizations should be given them at the time of the physical examination, but a signed authorization is of course required.  Otherwise the student must return for immunization with relevant "Important Information" forms signed by a parent or guardian.  The health provider will, as necessary, bring the Immunization and Sensitivity Record (HRSA-216) up to date.
      5. The health provider will secure the signature of a parent or guardian on the Consent Form (HRSA-47) and give copy 3 to the signatory.
      6. The IHS staff will either give the following documents directly to the student or the parent/guardian or transmit them to the agency or tribal education office.
        1. Photocopy of completed Report of Medical Examination (HRSA-197).
        2. Photocopy of up-to-date Immunization and Sensitivity Record (HRSA-216).
        3. Copies 1 and 2 of Consent Form (HRSA-47).
    4. Responsibility of School Health Clinic
      1. Routine School Admissions
        1. Within four weeks the available health documents of each student are to be reviewed for completeness and necessary action.
        2. Each student's health program is to be carried forward as indicated (including scheduling of dental, hearing or visual examinations as necessary).
        3. In the case of incomplete or missing reports, the necessary information is to be obtained as described for emergency placements.
      2. Emergency School Placement
        1. The director of the school health clinic will within one week of notification of an emergency school placement send a written request to the IHS Service Unit Director (SUD) of the student's home health care facility for:

          Prompt forwarding of a copy of the Immunization and Sensitivity Record (HRSA-216).

          Prompt forwarding of a copy of the Report of Medical Examination (HRSA-197), as nearly completely filled out as local health records will permit.

          Forwarding of signed copies 1 and 2 of the Consent Form (HRSA-47) as soon as these can be obtained.  (Copy 2 is to be transmitted to the school administrative office).

          It is recommended that these requests be made also by telephone, and directed to the person (e.g., health records chief, clinical director, clinic nurse, community health nurse) designated by the SUD as responsible for securing and forwarding the information.

        2. If the requested material is not received within three weeks, the director of the school health clinic will once again write the SUD, sending a copy of this communication to the IHS Area Director.
        3. The student's health plan is to be carried forward as indicated following review of his records (including scheduling of dental, hearing and visual examinations as necessary).  After three weeks if the Report of Medical Examination (HRSA-197) is not yet available, a physical examination should be done.
    5. Updating of Immunizations
      1. Routine Immunization.  Needed immunizations may be given only after receipt of the Consent stub(s) of the relevant "Important Information" form(s), signed by an "Authorized Person."  The Authorized Person is the parent or guardian, or the student him/herself if of adult age as defined by the law of the State in which the school is located.
      2. Acute Traumatic Injury.  A tetanus/diphtheria (Td) booster may be given in emergency situations without formally signed authorization, if recommended by a health provider.  It is advisable, however, that an Authorized Person be contacted after the fact and requested to sign for the Immunization.
Footnotes

(1) Agency is defined to include:

  1. An Area education office directed by an education program administrator;
  2. An Agency education office directed by an agency superintendent for education (ASE); and
  3. A field education office served by an education specialist or social worker, located at an agency office where there is not an ASE.

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