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Ensuring the well-being and safety of students is paramount for an enriching educational environment, which is precisely the intent behind the Har 3 Connecticut Health Assessment Record. This comprehensive document is an essential requirement for students entering schools in Connecticut, playing a pivotal role in identifying and addressing health needs that may affect a student’s learning journey. The form is divided into two main parts: Part I, which needs to be completed by the parent or guardian, gathers crucial information regarding the child's health history, including any conditions, hospitalizations, allergies, and medications. Furthermore, it seeks parental consent for sharing this information with school health officials. Part II is designated for the medical evaluation conducted by a qualified health care provider, detailing the physical examination results and confirming the student's immunization status as per state law requirements. Additionally, the form is utilized for annual health assessments for students participating in sports, ensuring they are fit for physical activity. This record not only complies with the Connecticut General Statutes Sections 10-204a and 10-206, mandating complete primary immunizations and health assessments prior to school entrance but also facilitates a proactive approach to managing and supporting students’ health needs throughout their educational phases. Through the Har 3 Connecticut form, schools, parents, and health care providers collaborate to foster a learning environment that acknowledges and adapts to each student's health requirements.

Har 3 Connecticut Sample

State of Connecticut Department of Education

Health Assessment Record

To Parent or Guardian:

In order to provide the best educational experience, school personnel must understand your child’s health needs. This form requests information from you (Part I) which will also be helpful to the health care provider when he or she completes the medical evaluation (Part II).

State law requires complete primary immunizations and a health assessment by a legally qualiied practitioner of medicine, an advanced

practice registered nurse or registered nurse, a physician assistant or the school medical advisor prior to school entrance in Connecticut (C.G.S.

Secs. 10-204a and 10-206). An immunization update and additional health assessments are required in the 6th or 7th grade and in the 9th or 10th grade. Speciic grade level will be determined by the local board of education. This form may also be used for health assessments required

every year for students participating on sports teams.

Please print

Student Name (Last, First, Middle)

Birth Date

 

❑ Male ❑ Female

 

 

 

 

 

Address (Street, Town and ZIP code)

 

 

 

 

 

 

 

 

 

Parent/Guardian Name (Last, First, Middle)

Home Phone

 

Cell Phone

 

 

 

School/Grade

Race/Ethnicity

❑ Black, not of Hispanic origin

 

❑ American Indian/

❑ White, not of Hispanic origin

 

Alaskan Native

❑ Asian/Paciic Islander

Primary Care Provider

 

❑ Hispanic/Latino

❑ Other

 

 

 

 

 

Health Insurance Company/Number* or Medicaid/Number*

Does your child have health insurance?

Y

N

If your child does not have health insurance, call 1-877-CT-HUSKY

Does your child have dental insurance?

Y

N

 

 

 

 

 

* If applicable

 

 

 

Part I — To be completed by parent/guardian.

Please answer these health history questions about your child before the physical examination.

Please circle Y if “yes” or N if “no.” Explain all “yes” answers in the space provided below.

Any health concerns

Y

N

Hospitalization or Emergency Room visit Y

N

Concussion

Y

N

Allergies to food or bee stings

Y

N

Any broken bones or dislocations

Y

N

Fainting or blacking out

Y

N

Allergies to medication

Y

N

Any muscle or joint injuries

Y

N

Chest pain

Y

N

Any other allergies

Y

N

Any neck or back injuries

Y

N

Heart problems

Y

N

Any daily medications

Y

N

Problems running

Y

N

High blood pressure

Y

N

Any problems with vision

Y

N

“Mono” (past 1 year)

Y

N

Bleeding more than expected

Y

N

Uses contacts or glasses

Y

N

Has only 1 kidney or testicle

Y

N

Problems breathing or coughing

Y

N

 

 

 

 

 

 

 

 

 

Any problems hearing

Y

N

Excessive weight gain/loss

Y

N

Any smoking

Y

N

Any problems with speech

Y

N

Dental braces, caps, or bridges

Y

N

Asthma treatment (past 3 years)

Y

N

 

 

 

 

 

 

 

 

 

Family History

 

 

 

 

 

Seizure treatment (past 2 years)

Y

N

Any relative ever have a sudden unexplained death (less than 50 years old)

Y

N

Diabetes

Y

N

 

 

 

 

 

 

Any immediate family members have high cholesterol

Y

N

ADHD/ADD

Y

N

 

 

 

 

 

 

 

 

 

Please explain all “yes” answers here. For illnesses/injuries/etc., include the year and/or your child’s age at the time.

Is there anything you want to discuss with the school nurse? Y N If yes, explain:

Please list any medications your child will need to take in school:

All medications taken in school require a separate Medication Authorization Form signed by a health care provider and parent/guardian.

I give permission for release and exchange of information on this form between the school nurse and health care provider for conidential

use in meeting my child’s health and educational needs in school. Signature of Parent/Guardian

Date

 

 

HAR-3 REV. 4/2011

TO BE MAINTAINED IN THE STUDENT’S CUMULATIVE SCHOOL HEALTH RECORD

Part II — Medical Evaluation

HAR-3 REV. 4/2011

Health Care Provider must complete and sign the medical evaluation and physical examination

Student Name

 

Birth Date

 

Date of Exam

❑I have reviewed the health history information provided in Part I of this form

Physical Exam

Note: *Mandated Screening/Test to be completed by provider under Connecticut State Law

*Height _____ in. / _____% *Weight _____ lbs. / _____%

BMI _____ / _____% Pulse _____

*Blood Pressure _____ / _____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Normal

 

Describe Abnormal

 

 

Ortho

 

 

Normal

 

Describe Abnormal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neurologic

 

 

 

 

 

 

Neck

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEENT

 

 

 

 

 

 

Shoulders

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Gross Dental

 

 

 

 

 

 

Arms/Hands

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lymphatic

 

 

 

 

 

 

Hips

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart

 

 

 

 

 

 

Knees

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lungs

 

 

 

 

 

 

Feet/Ankles

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Abdomen

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Postural

❑ No spinal

❑ Spine abnormality:

 

 

 

 

 

 

 

 

Genitalia/ hernia

 

 

 

 

 

 

 

 

abnormality

 

❑ Mild

❑ Moderate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❑ Marked ❑ Referral made

Skin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Screenings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Vision Screening

 

 

 

*Auditory Screening

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

Type:

Right

Left

 

Type:

Right

Left

 

 

Lead:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❑ Pass

❑ Pass

 

 

 

 

 

 

 

With glasses

20/

20/

 

 

 

 

*HCT/HGB:

 

 

 

 

 

 

 

 

 

 

❑ Fail

❑ Fail

 

 

 

 

 

 

 

 

 

Without glasses

20/

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Speech (school entry only)

 

 

 

 

 

 

 

 

 

 

 

 

 

❑ Referral made

 

 

 

❑ Referral made

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TB: High-risk group?

❑ No

❑ Yes

 

PPD date read:

 

 

Results:

 

 

 

Treatment:

 

 

 

*IMMUNIZATIONS

❑Up to Date or ❑ Catch-up Schedule: MUST HAVE IMMUNIZATION RECORD ATTACHED

*Chronic Disease Assessment:

Asthma

❑ No

❑ Yes:

❑ Intermittent ❑ Mild Persistent ❑ Moderate Persistent ❑ Severe Persistent ❑ Exercise induced

 

If yes, please provide a copy of the Asthma Action Plan to School

 

Anaphylaxis ❑ No

❑ Yes:

❑ Food

❑ Insects

❑ Latex

❑ Unknown source

 

Allergies

If yes, please provide a copy of the Emergency Allergy Plan to School

 

 

History of Anaphylaxis

❑ No

❑ Yes

Epi Pen required ❑ No

❑ Yes

Diabetes

❑ No

❑ Yes:

❑ Type I

❑ Type II

Other Chronic Disease:

 

Seizures

❑ No

❑ Yes, type:

 

 

 

 

❑This student has a developmental, emotional, behavioral or psychiatric condition that may affect his or her educational experience. Explain: ____________________________________________________________________________________________________

Daily Medications (specify): ____________________________________________________________________________________

This student may: ❑ participate fully in the school program

❑participate in the school program with the following restriction/adaptation: _____________________________

___________________________________________________________________________________________________________

This student may: ❑ participate fully in athletic activities and competitive sports

❑participate in athletic activities and competitive sports with the following restriction/adaptation: ____________

___________________________________________________________________________________________________________

❑Yes ❑ No Based on this comprehensive health history and physical examination, this student has maintained his/her level of wellness.

Is this the student’s medical home? ❑ Yes ❑ No ❑ I would like to discuss information in this report with the school nurse.

 

 

 

 

 

 

Signature of health care provider MD / DO / APRN / PA

Date Signed

Printed/Stamped Provider Name and Phone Number

 

 

 

 

 

Student Name: ______________________________________ Birth Date: ___________________

Immunization Record

To the Health Care Provider: Please complete and initial below.

HAR-3 REV. 4/2011

Vaccine (Month/Day/Year) Note: *Minimum requirements prior to school enrollment. At subsequent exams, note booster shots only.

 

Dose 1

Dose 2

 

Dose 3

 

Dose 4

 

Dose 5

 

Dose 6

 

 

 

 

 

 

 

 

 

 

 

 

 

DTP/DTaP

*

*

 

*

 

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DT/Td

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tdap

*

 

 

 

 

 

 

Required for 7th grade entry

 

 

 

 

 

 

 

 

 

 

 

 

 

IPV/OPV

*

*

 

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MMR

*

*

 

 

 

 

 

Required K-12th grade

 

 

 

 

 

 

 

 

 

 

 

Measles

*

*

 

 

 

 

 

Required K-12th grade

 

 

 

 

 

 

 

 

 

 

 

Mumps

*

*

 

 

 

 

 

Required K-12th grade

 

 

 

 

 

 

 

 

 

 

 

Rubella

*

*

 

 

 

 

 

Required K-12th grade

 

 

 

 

 

 

 

 

 

 

 

HIB

*

 

 

 

 

 

 

PK and K (Students under age 5)

 

 

 

 

 

 

 

 

 

 

 

Hep A

*

*

 

 

 

 

 

PK and K (born 1/1/2007 or later)

 

 

 

 

 

 

 

 

 

 

 

Hep B

*

*

 

*

 

 

 

Required PK-12th grade

 

 

 

 

 

 

 

 

 

 

 

Varicella

*

*

 

 

 

 

 

2 doses required for K & 7th grade as of 8/1/2011

 

 

 

 

 

 

 

 

 

 

 

 

PCV

*

 

 

 

 

 

 

PK and K (born 1/1/2007 or later)

 

 

 

 

 

 

 

 

 

 

 

Meningococcal

*

 

 

 

 

 

 

Required for 7th grade entry

 

 

 

 

 

 

 

 

 

 

 

 

 

HPV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Flu

*

 

 

 

 

 

 

PK students 24-59 months old – given annually

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disease Hx ________________________________

________________________________

________________________________

 

 

of above

(Specify)

 

 

(Date)

 

 

 

(Conirmed by)

 

 

 

 

 

 

 

Exemption

 

 

 

 

 

 

 

 

 

Religious _____ Medical: Permanent _____

Temporary _____ Date _____

 

 

 

 

Recertify Date _________

Recertify Date _________ Recertify Date ________

 

 

 

Immunization Requirements for Newly Enrolled Students at Connecticut Schools

KINDERGARTEN

•DTaP: At least 4 doses. The last dose must be given on or after 4th birthday.

•Polio: At least 3 doses. The last dose must be given on or after 4th birthday.

•MMR: 2 doses given at least 28 day apart – 1st dose on or after the 1st birthday.

•Hib: 1 dose on or after 1st birthday (Children 5 years and older do not need proof of Hib vaccination).

•Pneumococcal: 1 dose on or after 1st birthday (born 1/1/2007 or later and less than 5 years old).

•Hep A: 2 doses given six months apart-1st dose on or after 1st birthday.

•Hep B: 3 doses-the last dose on or after 24 weeks of age.

•Varicella: For students enrolled before August 1, 2011, 1 dose given on or after 1st birthday; for students enrolled on or after August 1, 2011

2 doses given 3 months apart – 1st dose on or after 1st birthday or veriication of disease*.

GRADES 1-6

•DTaP /Td/Tdap: At least 4 doses. The last dose must be given on or after 4th birthday;

students who start the series at age 7 or older only need a total of 3 doses of tetanus-diphtheria containing vaccine.

•Polio: At least 3 doses. The last dose must be given on or after 4th birthday.

•MMR: 2 doses given at least 28 days apart- 1st dose on or after the 1st birthday.

•Hep B: 3 doses – the last dose on or after 24 weeks of age.

•Varicella: 1 dose on or after the 1st birthday or veriication of disease*.

GRADE 7

•Tdap/Td: 1 dose of Tdap for students 11 yrs. or older enrolled in 7th grade who completed their primary DTaP series; For those students who start the series at age 7 or older a total of 3 doses of tetanus-diphtheria containing vac- cines are needed, one of which must be Tdap.

•Polio: At least 3 doses. The last dose must be given on or after 4th birthday.

•MMR: 2 doses given at least 28 days apart – 1st dose on or after the 1st birthday.

•Meningococcal: one dose for students enrolled in 7th grade.

•Hep B: 3 doses-the last dose on or after 24 weeks of age.

•Varicella: 2 doses given 3 months apart – 1st dose on or after 1st birthday or veriication of

disease*.

GRADES 8-12

•Td: At least 3 doses. Students who start the series at age 7 or older only need a total of 3 doses of tetanus-diphtheria containing vaccine one of which should be Tdap.

•Polio: At least 3 doses. The last dose must be given on or after 4th birthday.

•MMR: 2 doses given at least 28 days apart- 1st dose on or after the 1st birthday.

•Hep B: 3 doses-the last dose on or after 24 weeks of age.

•Varicella: For students <13 years of age, 1 dose given on or after the 1st birthday. For

students 13 years of age or older, 2 doses given at least 4 weeks apart or veriication of

disease*.

*Veriicationofdisease:Conirmation in writ- ing by a MD, PA, or APRN that the child has a previous history of disease, based on family or medical history.

 

 

 

 

 

 

Initial/Signature of health care provider MD / DO / APRN / PA

Date Signed

Printed/Stamped Provider Name and Phone Number

 

 

 

 

 
⇓ Har 3 Connecticut PDF

Document Features

Fact Detail
1. Purpose To understand a child’s health needs for the best educational experience.
2. Components Two parts: Part I for the parent/guardian, Part II for the medical evaluation by a health care provider.
3. Legal Requirement State law requires complete primary immunizations and a health assessment for school entrance in Connecticut.
4. Required Grades for Additional Health Assessments Assessments required in the 6th or 7th grade and in the 9th or 10th grade, specifics determined by the local board of education.
5. Use for Sports Yearly health assessments required for students participating in sports teams.
6. Parent/Guardian Section Includes health history questions that need to be completed before the physical examination.
7. Healthcare Provider Section Includes medical evaluation, physical examination, and must be completed and signed by a qualified health care provider.
8. Immunization Requirements Specific vaccines listed with minimum requirements by grade, including booster shots and updates.
9. Governing Laws C.G.S. Secs. 10-204a and 10-206.
10. Chronic Disease Assessment Includes assessments for asthma, anaphylaxis, diabetes, seizures, and other conditions to be shared with the school.

How to Use Har 3 Connecticut

Filling out the Health Assessment Record (HAR-3) for a Connecticut student involves precise documentation of personal details and health history. This form is crucial for the Department of Education and school personnel to provide tailored educational experiences and ensure state health requirements are met for school entrance and participation in certain programs. Accuracy and thoroughness in completing this form not only comply with Connecticut General Statutes Sections 10-204a and 10-206 but also equip school healthcare providers with essential information for supporting your child's health and educational needs.

  1. Start by printing the student's name (Last, First, Middle) at the top of the form.
  2. Fill in the student's birth date, checking the appropriate box for Male or Female.
  3. Enter the student's address (Street, Town, and ZIP code).
  4. Provide the parent or guardian's name (Last, First, Middle), home phone, and cell phone numbers.
  5. Specify the school/grade of the student and select their race/ethnicity from the provided options.
  6. Enter the Primary Care Provider's name, the health insurance company/number, or Medicaid number if applicable. If the child does not have health insurance, note the contact information for CT-HUSKY.
  7. Complete Part I by answering health history questions about your child, circling Y for "yes" and N for "no". Provide explanations for any "yes" answers in the space given.
  8. List any medications your child will need to take at school, understanding a separate Medication Authorization Form is required for each medication.
  9. Sign and date the form, granting permission for the release and exchange of this information between the school nurse and healthcare provider.
  10. In Part II, to be completed by a health care provider, they will review the health history provided in Part I, complete the medical evaluation, and document the physical examination results. Ensure all mandatory screenings/tests as dictated by Connecticut State Law are completed and recorded
  11. The health care provider must also update the immunization recordv section, initialing and dating to confirm each vaccine or noting any exemptions on the grounds of medical or religious reasons.
  12. After completion of the health evaluation and updating the immunization records, the healthcare provider signs and dates the form, then prints/stamps their name and phone number.

Once the HAR-3 form is fully completed and signed by both the parent/guardian and the healthcare provider, it is ready for submission to the student's school as part of the required health documentation. This ensures compliance with Connecticut's health assessment requirements for school participation, supports your child's health and safety in the school environment, and facilitates accessibility to health-related accommodations or interventions as needed.

More About Har 3 Connecticut

  1. What is the purpose of the HAR-3 Connecticut Health Assessment Record?

    The HAR-3 Connecticut Health Assessment Record is a comprehensive form utilized to gather vital health information about a student to ensure they receive the appropriate support for their health needs while attending school. It consists of two parts: Part I, which is filled out by the parent or guardian, detailing the child's health history, and Part II, a medical evaluation completed by a qualified health care provider. This information aids in understanding and accommodating the student’s health requirements, thereby enhancing their educational experience. The state of Connecticut mandates the completion of this form for school entrance, as well as for participation in certain grade levels and school sports teams, in accordance with C.G.S. Secs. 10-204a and 10-206.

  2. Who is required to complete the HAR-3 Connecticut Health Assessment Record?

    The HAR-3 Connecticut Health Assessment Record must be completed in two parts. Part I must be filled out by the parent or guardian who will provide detailed information regarding the child's health history. Part II is to be completed by a legally qualified health care provider, which includes physicians, advanced practice registered nurses, registered nurses, physician assistants, or the school medical advisor. This section involves a detailed medical evaluation and physical examination of the student. Both parts are crucial for the comprehensive understanding of the student's health needs.

  3. Are immunizations required for the completion of the HAR-3 form?

    Yes, immunizations are a critical part of the HAR-3 Connecticut Health Assessment Record. The form requires an up-to-date immunization record attached to it, adhering to Connecticut's state laws for school enrollment. This requirement includes primary immunizations before school entrance and additional immunizations at specified grade levels. The HAR-3 form outlines specific immunizations and the required doses based on the student's grade level, ensuring they meet the state's health criteria for school attendance.

  4. What happens if a child does not have health insurance?

    If a child does not have health insurance, the HAR-3 form encourages parents or guardians to contact the Connecticut HUSKY Plan for assistance. HUSKY Health provides a comprehensive health care benefit package for children and teenagers, including services such as doctor visits, prescription medications, and dental needs, among others. This support aims to ensure that all children in Connecticut have access to necessary health services, regardless of their insurance status.

  5. Can the HAR-3 form be used for health assessments for sports teams?

    Yes, the HAR-3 Connecticut Health Assessment Record can also be utilized for yearly health assessments required for student participation in sports teams. This ensures that the students meet health standards for safe participation in physical activities and that any special health considerations are identified and managed appropriately. It thereby serves a dual purpose, not only facilitating entrance and transitions within the school system but also ensuring the safety and well-being of students engaging in sports.

Common mistakes

Filling out the HAR-3 Connecticut Health Assessment Record can be a breeze, but sometimes people trip up on a few common pitfalls. Let's go through six mistakes that often occur, so you can avoid them when completing this form for a child.

  1. Skipping sections: Every part of this form is crucial. Part I asks for health history and must be filled out by the parent or guardian, while Part II is for the health care provider to complete during the medical evaluation. It's essential not to miss any section to ensure a comprehensive understanding of the child's health needs.

  2. Forgetting to answer all the yes/no questions in Part I: These questions cover a range of health-related issues, from allergies to past hospital visits. It's important to circle either "Y" for yes or "N" for no, for each question to provide a complete health history.

  3. Not explaining "yes" answers: Whenever you answer "yes" to a question in Part I, you must provide details in the space provided. This could include dates, specifics of the medical issue, or any relevant details. Failing to do so can leave out critical information about the child's health history.

  4. Incorrect or incomplete immunization records: The immunization record is a critical part of Part II, and it must match up with state requirements. Make sure all dates of vaccines are accurately recorded and that the child is up-to-date according to Connecticut's vaccination schedule.

  5. Leaving out the signature and date: The form requires the signature of the parent or guardian, along with the date when completed. This authenticates the information provided, ensuring it is accurate to the best of the guardian's knowledge.

  6. Omitting the health care provider's details and signature in Part II: After the medical evaluation, the health care provider must sign off on the physical examination and any screenings or assessments conducted. This part also verifies that the child's medical history has been reviewed and is accurate.

Being mindful of these common mistakes can save time and ensure the form is accepted without issues. It's all about providing clear and comprehensive information to support the child's health and educational experience. Whether it's ensuring all sections are filled out, providing detailed explanations for "yes" answers, or accurately recording immunization dates, each step is vital. Remember, this form plays an essential role in facilitating a supportive learning environment, tailored to the child's specific health needs.

Documents used along the form

When completing health-related forms for school, it's often not just about handing in one form. The State of Connecticut Department of Education Health Assessment Record (HAR-3 Form) is a critical document for ensuring that students' health needs are met and understood by school personnel. However, to provide a comprehensive overview of a student's health status, additional forms and documents are frequently required. Below is a list of other common forms and documents that are often used alongside the HAR-3 Connecticut Form.

  • Immunization Record: This essential document provides a history of all the vaccines a student has received. It is crucial for verifying compliance with school health requirements.
  • Medication Authorization Form: For students who need to take medication during school hours, this form, signed by a health care provider and a parent or guardian, authorizes the administration of that medication.
  • Asthma Action Plan: For students with asthma, this form outlines the steps to take in managing the student's asthma, including medications, triggers, and emergency procedures.
  • Emergency Allergy Action Plan: Similar to the asthma plan, this document is used for students with allergies. It details the allergens, symptoms of an allergic reaction, and steps to take in case of an allergy emergency.
  • Seizure Action Plan: Students with epilepsy or seizure conditions have this form on file. It provides detailed information on how to recognize and respond to a seizure.
  • Special Dietary Needs Form: For students with dietary restrictions or allergies, this form helps ensure they are provided with safe and appropriate meals and snacks at school.
    • Vision Examination Report: A document detailing the results of a student's vision screening. It may recommend further evaluation or specify corrective lenses are necessary.
    • Dental Health Assessment Record: This form provides information on a student's dental health, ideally completed by a dentist. It may indicate the need for dental care or treatments.
    • Sports Clearance Form: For students participating in sports, this form, completed by a healthcare provider, confirms that a student is physically able to participate in athletic activities.

    Collectively, these forms and documents contribute to a comprehensive view of a student's health, ensuring that schools can provide a safe and supportive environment for all students. While the HAR-3 Connecticut Form starts the process, these additional documents ensure that every aspect of student health is considered and managed appropriately.

Similar forms

The Har 3 Connecticut form is similar to other health forms used across the United States for school children, requiring both medical history and immunization records. Specifically, it can be likened to the California School Immunization Record (CSIR) and the New York State Student Health Examination Form for School Entrance.

The California School Immunization Record (CSIR) shares similarities with the Har 3 Connecticut form in that it collects detailed immunization history needed for school entrance and progression to certain grade levels. Both forms ensure compliance with state laws regarding vaccinations, such as mandates for DTP/DTaP, Polio, MMR, and Varicella among others, before allowing enrollment into schools. The CSIR, just like the Har 3, is integral in the school enrollment process, serving as a checkpoint for public health safety within educational environments. However, the CSIR is primarily focused on immunizations and does not extensively cover the health history and physical examination components found in the Har 3 form.

The New York State Student Health Examination Form for School Entrance also parallels the Har 3 Connecticut form in several aspects. Both documents require completion by a health care provider and cover the student's entire health overview, including immunizations, medical history, physical examinations, and chronic conditions. They play a crucial role in identifying health issues that could affect a student's educational experience, ensuring necessary accommodations are made. Additionally, both forms have sections dedicated to allowing health care providers to communicate any special conditions or needs directly to the school, ensuring a tailored educational approach. Unlike the Har 3, New York's form places a significant emphasis on documenting the physical examination findings in a more detailed manner.

Dos and Don'ts

When filling out the Health Assessment Record (HAR 3) Connecticut form, it's important to carefully provide accurate and comprehensive information to ensure your child receives the necessary care and support in school. Here are some dos and don'ts to help guide you through the process:

Dos:

  1. Thoroughly complete Part I of the form, providing detailed answers to all health history questions about your child. This information is crucial for understanding any conditions that could affect your child's educational experience.
  2. Ensure you list any and all medications your child is currently taking, including the dosage and frequency. Remember, any medication to be administered at school requires a separate Medication Authorization Form signed by both a health care provider and the parent or guardian.
  3. Sign and date the form to authorize the release and exchange of medical information between the school nurse and your child's health care provider. This step is necessary for the coordination of care.
  4. Attach your child's immunization record to the HAR-3 form as required for school entrance and include any additional health information that could assist in emergency situations, such as an Asthma Action Plan or an Emergency Allergy Plan if applicable.

Don'ts:

  1. Don't leave any sections incomplete. If a question does not apply to your child, it's better to write "N/A" than to leave it blank, to avoid any assumptions of oversight.
  2. Avoid giving vague responses in Part I of the form. Detailed information helps school health officials to better understand and meet your child's health needs.
  3. Do not forget to update the health care provider section of the form if your child has changed providers or if there are additional specialists that contribute to your child's health care.
  4. Refrain from withholding information regarding your child's health history or current health status out of concern for privacy. The information provided is used solely for the purpose of ensuring the best care and accommodations for your child while at school.

Misconceptions

Understanding the complexities and requirements of health assessments in schools can be challenging for parents and guardians. Common misconceptions about the Connecticut Health Assessment Record (HAR-3) form can lead to confusion, potentially impacting the health and educational experience of students. Addressing these misunderstandings is crucial for ensuring compliance with state health requirements and enhancing student welfare.

  • Only for New Entrants: A common misconception is that the HAR-3 form is required solely at the time of a child’s initial entry into the Connecticut school system. In reality, the form is required for initial school entry, with additional health assessments mandated in the 6th or 7th grade, and again in the 9th or 10th grade. It’s also necessary for annual sports participation, underscoring its importance at various educational stages.

  • Complete Parent Section Optional: Some may believe that completing the parent/guardian section (Part I) of the HAR-3 form is optional. However, this section provides critical health history and information about the child that can aid healthcare providers in conducting a thorough evaluation and making informed decisions.

  • Immunization Record Not Required: It’s mistakenly thought that the immunization record doesn’t need to be attached. The opposite is true; a current immunization record must be attached to the HAR-3 form to meet Connecticut school enrollment requirements, ensuring that all students abide by health and safety regulations.

  • Privacy Concerns: Privacy concerns often stem from misunderstandings about how the information provided will be used. The information on the HAR-3 form is used strictly for ensuring that health and educational needs are met, with strict confidentiality protocols in place to protect personal information.

  • No Updates Required for Existing Conditions: There is a belief that once a condition is reported, it does not need to be updated on subsequent HAR-3 forms. In truth, updating health information is crucial, especially if there are changes in the child’s health status, to provide timely and effective care.

  • Dental Insurance Information Is Irrelevant: The question regarding dental insurance may seem unrelated to a child’s general health assessment. However, dental health can significantly impact overall well-being, making this information pertinent for a comprehensive health overview.

  • Physician’s Signature Not Necessary: Lastly, some might think a healthcare provider’s review and signature on Part II of the form isn’t required if the parent completes their section thoroughly. Contrary to this belief, a healthcare provider must complete, review, and sign the medical evaluation to comply with state laws and ensure all health issues are appropriately addressed.

Dispelling these misconceptions is vital for the success of health programs within schools and the well-being of students. By clearly understanding the requirements and intentions behind the HAR-3 form, parents, and guardians can play an active role in managing their child’s health needs in collaboration with educational and health care providers.

Key takeaways

The State of Connecticut Department of Education requires the Health Assessment Record (HAR-3) for school enrollment, highlighting the importance of understanding a child's health needs for optimal educational experience.

This form is divided into two main parts: Part I is to be filled out by the parent or guardian, providing essential health history and concerns, while Part II is for the completion and signature of a legally qualified health care provider following a medical evaluation and physical examination of the student.

Connect Ratification Law mandates that all students entering school in Connecticut must have completed primary immunizations and a health assessment. Further assessments are required at specific grade levels as determined by the local board of education, including updates for students participating in sports teams annually.

  • Parents or guardians must accurately complete Part I, which includes health history questions that will assist the health care provider during the medical evaluation.
  • It's critical to explain all "yes" answers in Part I, providing information about any illnesses, injuries, or health concerns, and specifying your child's needs, including any medications required during school hours.
  • The form also serves as a communication tool between the school nurse and the health care provider, ensuring the student's health and educational needs are adequately met.
  • Comprehensive immunization records must be attached to the form as required by Connecticut state law, including specific vaccines and doses prior to school enrollment.
  • Health care providers are tasked with reviewing the student's health history, conducting a thorough physical examination, and completing the mandated screenings and tests as outlined in Part II.
  • An update on immunizations and additional health assessments are mandatory for enrollment in certain grades, demonstrating the state's commitment to maintaining public health standards in school environments.
  • Part II of the form allows health care providers to detail any chronic diseases, developmental, emotional, behavioral, or psychiatric conditions that might affect the student's educational experience, and to advise on participation in school programs and athletic activities.
  • Ensuring this form is filled out thoroughly and accurately is critical for the safety and wellbeing of students, facilitating appropriate health and educational support while complying with Connecticut State Law.

Ultimately, the HAR-3 form is a vital document in the academic and health protocol of Connecticut schools, ensuring children receive the support and care they need to succeed in their educational journey.

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