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HEALTH ENROLLMENT HEALTH ENROLLMENT TRAININGTRAININGMAY 9, 2011MAY 9, 2011MATILDA ELIZONDOMATILDA ELIZONDO
Health Services Timelines Health Services Timelines and Process Diagramand Process DiagramIllustrates the Health processes that we
must conduct during the Head Start year.
◦Which includes the:
Initial sensory and developmental (vision, strabismus, hearing) screenings
Establishment of medical and dental homes
Identification of additional health concerns during the child’s enrollment
Health TimelinesHealth Timelines
Medicaid’s Early Periodic Medicaid’s Early Periodic Screening Diagnostic, and Screening Diagnostic, and Treatment programTreatment programTo ensure that children receiveprompt medical and dental evaluation and/ortreatment, Head Start staff assist families toobtain a source of funding for health
services,such as Medicaid’s Early Periodic Screening,Diagnostic, and Treatment program (EPSDT).
Iffunds are not available to families, then HeadStart funds may be used [45 CFR 1304.20(c)
(5)].
EPSDTEPSDT
Early: Assessing a child's health early in life sothat potential diseases and disabilities can beprevented or detected in the early stages, whenthey can be treated most effectively;
Periodic: Assessing children's health at keypoints to assure continued healthy development;
Screening: Using tests and procedures todetermine if children screened have conditionsrequiring closer medical or dental attention,including attention to mental health problems;
Diagnostic: Determining the nature and causeof conditions identified by screenings and thoserequiring further attention; and
Treatment: Providing services needed to control,correct, or reduce physical and mentalhealth problems.
THSteps Medical Check-ups Periodicity THSteps Medical Check-ups Periodicity Schedule for Infants, and Children, (Birth Schedule for Infants, and Children, (Birth Through 10 Years of Age) Through 10 Years of Age)
Attendance PolicyAttendance Policy1305.8 (a)(b)(c)1305.8 (a)(b)(c)
Processes, Documents and Tracking:◦1. A complete and up to date health
exam is required for all children prior to attendance at a licensed grantee site.
◦2. A complete and up to date health exam is required for all children to be completed at scheduled onsite clinics or prior to attendance at partner sites.
Memorandum Of Memorandum Of UnderstandingUnderstanding
(Mou’s)(Mou’s)Federally funded clinics to be used for physicals and dentals of Head Start children.
Four(4) clinics will have Mou’s with Head Start.◦Community Health Center of
Lubbock 1318 Broadway, Lubbock, Texas 79401-3206 806-765-2611 extension 1029
Mou’sMou’s
Larry Combest Community Health and Wellness Center
301 E. 40th Street, Lubbock, Texas 79404- 2811 806-743-9355
South Plains Rural Health Services, Inc. 1000 Fm 300, Levelland, Texas 79336-6235 806-894-7842 extension 154
Regence Health Network 2801 W. 8th Street, Plainview, Texas 79072-6737 806-293-8561 extension 318
ResourcesResourcesTexas Health Steps providers are
on-line! An up-to date list of Region 1 THStepsproviders can be found at:
Medical providerswww.dshs.state.tx.us/region1/thstepsmedical.shtm
Dental providerswww.dshs.state.tx.us/region1/thstepsdental.shtm
Case Management providerswww.dshs.state.tx.us/region1/thstepscaseman.shtm
Parent Consent for Parent Consent for ServicesServices
Print all information using Blue ink pen! Do not leave any blanks. Section 1.- Put child’s full name Section 2.- We prefer all answers to be YES,
however if parent answers NO, FSW’s will need to re-ask to clarify answer if still NO document and let CD/TL know.
#11 is a new question- permission for children’s picture to be taken.
Section 3.-Must be signed and dated by the staff person completing the form. Ensure the Parent or Guardian have also signed.
Form will be entered into Child Plus by FSW’s, and filed in the child’s brown folder under flap #5.
Consent To Release or To Consent To Release or To Request Confidential Request Confidential
InformationInformation1.All parents’ sign a Consent To Release
or To Request Confidential Information at the time they enroll into the program.
2.This consent will be used if we need to get the needed information from the provider.
Deleted from the form was the following Statement: or at such time that the child is no longer enrolled in the program.
Consent for Release or to Consent for Release or to Request Confidential Request Confidential
InformationInformation Print all information using Blue ink pen! Do not leave any blanks. Section 1.-Check proper box, child’s name and date of
birth. Section 2.- Left side of form is for Head Start staff to fill
out Section 3.- Right side of form is for Agency to whom
request made. Section 4.-Check proper box for information being
requested. Section 5.-Staff name and telephone number. Section 6.-Check proper box for yes or no answer. Section 7.- Signature of Parent, Guardian, or Surrogate
parent and dated. Section 8.- Must be signed and dated by interpreter if
used. Deleted from the form was the following Statement: or at
such time that the child is no longer enrolled in the program.
Consent for Lead and/or Consent for Lead and/or Hematrocrit Testing using a Hematrocrit Testing using a
Finger Stick Method Finger Stick Method All parents’ sign a Consent for
Lead and/or Hematocrit Testing using a Finger Stick Method at the time they enroll into the program.
This consent will be used if we can not get the needed results from the provider.
Consent for Lead and/or Consent for Lead and/or Hematocrit Testing using a Finger Hematocrit Testing using a Finger
Stick Method InstructionsStick Method Instructions All information must be printed and a Blue pen is to be used. Section #1, To be completed at time of enrollment as part of the
enrollment process. This form is good for one (1) year from date signed.
◦ Do not leave any blanks.
◦ Please fill in Medicaid or insurance information. Section #2, To be completed at time of enrollment as part of the
enrollment process.
◦ All blanks need to be completed.
◦ Please have parent complete address with City and Zip.
◦ Ethnicity and Race must be checked as this is used in reporting to the state of Texas.
◦ Please include the child’s primary physician and location. Section #3, To be completed by SPCAA Nurse at the time the blood
work is completed. The Consent for Lead and/or Hematocrit will be filed in the child’s
brown folder under flap #4 to be used if needed.
Medical and Dental Medical and Dental Emergency Consent/History Emergency Consent/History
FormForm Print all information using Blue ink pen! Do not leave any blanks. Section 1. complete parent’s name, child’s name
and site name. Section 2. – 4. print name, address with city,
state, and zip and phone number. Section 5.-7. print name, address with city, state
and zip and phone number. Section 8.- all answers are to be circled NO
unless you have a diagnosis from the medical provider at the time this form is completed.
Section 9. – must be signed by parent and staff and dated.
Form will be entered into Child Plus by FSW’s, and filed in the child’s brown folder under flap #5.
Physical LetterPhysical LetterPrint all information using Blue ink
pen!Do not leave any blanks.Section 1. – complete Center/Partner
Name, date, and child’s name.Section 2. - review section #2 with the
parent or guardian at time of enrollment.
Section 3. - all of these items must be completed on the physical exam form to be considered complete.
Section 4. - contact information for the parent.
Physical ExamPhysical Exam Print all information using Blue ink pen! Do not leave any blanks. Section 1.- Complete child’s name, sex, and birthdate. Site
name, address, and phone number including city, state, and zip. Also circle payment source.
Section 2. – transfer any YES answers from the Medical and Dental Emergency Consent/History from to this section for provider to address.
Section 3. – Screening test results completed by provider. Section 4. - physical exam section to be completed by
provider. Section 5. – any additional comments provided by physician
at time of physical exam. Section 6. – original medical provider’s signature and date. Section 7. – any findings, treatment, or recommendations
that will need follow-up. Form will be entered into Child Plus by Monitor’s, and filed
in the child’s brown folder under flap #4.
Dental Health FormDental Health Form Print all information using Blue ink pen! Do not leave any blanks. Section 1.- Complete child’s name, sex, and birthdate. Site
name, address, and phone number including city, state, and zip.
Section 2. - #1-8 must be completed by the staff person completing the enrollment.
Section 3. - #10 is to be completed by the dentist including the date the exam was performed.
Section 4. -5. are to be completed if preventive care was needed or completed.
Section 6.-to be completed by dentist for dental treatment. Section ‘A’ marked when treatment is needed and ‘B’ marked when NO treatment needed.
Section 7. – to be completed by dentist and checked YES or NO.
Section 8. – Dentist must check services are completed with original signature and date of Dentist performing services.
Form will be entered into Child Plus by Monitor’s, and filed in the child’s brown folder under flap #4.
Diet History for ChildrenDiet History for Children Print all information using Blue ink pen! Do not leave any blanks. Section 1. – complete with Center/Partner Name, child’s
name, and date Section 2. - #1.(a-f) are to be filled out with parent circling
how many times a day foods are eaten from food groups. Section 3.- #2. (a-i) are to be filled out with parent checking Yes or No.
Section 2 letter (e) indicates possible problems with PICA. When the response is YES to this question the Diet History for Children is entered into Child Plus as a failed event and a follow-up is needed to be completed by dietitian with the parent or guardian.
Section 4. – letters (j-o), ask parent and circle appropriate response. All YES answers must be explained in space provided.
Section 5. – must be signed and dated by parent and staff completing the form.
Section 6.- staff completing Diet History for Children with parent will need to check the following spaces at bottom of page: ( ) Reviewed response with parent ( ) Gave Child Pyramid handout
Form will be entered into Child Plus by FSW’s, and filed in the child’s brown folder under flap #6.
Tuberculosis (TB) Screening Tuberculosis (TB) Screening Education ToolEducation Tool
Print all information using Blue ink pen!Do not leave any blanks.Section 1. – complete with Center/Partner
name, child’s name, and date.Section 2. – an ‘X’ will be placed under the
section parent indicates. If any answers are “yes” or “I don’t know” the
child Must have a TB skin test completed and provide results.
When a “YES” or “I Don’t Know” is noted on the form TB questionnaire will be entered into Child Plus as a failed event
If child fails TB questionnaire after a TB test has been completed, the child will need an additional TB test.
Form will be entered into Child Plus by FSW’s, and filed in the child’s brown folder under flap #4.
Risk Assessment for Lead Risk Assessment for Lead Exposure: Parent Exposure: Parent
QuestionnaireQuestionnairePrint all information using Blue ink pen!Do not leave any blanks.Section 1. – complete with Center/Partner
name, child’s name, and date.Section 2. – an ‘X’ will be placed under the
section parent indicates. If “I Don’t Know: or “YES” is marked then the
child will need a lead test completed. When a “YES” or “I Don’t Know” is noted on the form
the Risk Assessment for Lead Exposure will be entered into Child Plus as a failed event
If child fails Lead questionnaire after a Lead test has been completed, the child will need an additional Lead test.
Form will be entered into Child Plus by FSW’s, and filed in the child’s brown folder under flap #4.
ImmTrac FormImmTrac FormPrint all information using Blue ink
pen!Section 1. - Do not leave any blanks
Be sure to include child’s middle name.
Section 2. - Parent or guardian must print name, sign and date form.
The ImmTrac form is not to be put in the child’s brown folder.
The ImmTrac form is sent to the Health Assistant by Inter office mail to the Levelland office.
Questions??????Questions??????Answers…..