The Commonwealth of Massachusetts

Executive Office of Health and Human Services
Department of Public Health
250 Washington Street, Boston, MA 02108-4619

MITT ROMNEY
GOVERNOR
KERRY HEALEY
LIEUTENANT GOVERNOR
RONALD PRESTON
SECRETARY
PAUL J. COTE, JR.
COMMISSIONER	

TO:		School Nurse and School Physicians

FROM:	Anne H. Sheetz
		Director of School Health Services

DATE:		April 20, 2005

SUBJ:		Massachusetts School Health Record

MEMORANDUM
______________________________________________________________________

Each student in the Commonwealth's schools is required to have a school health record.  During the past year, the Massachusetts Department of Public Health has collaborated with school nurses to update the existing face-sheet of the school health record.  The goal of this process was to identify information needed by the school to protect the health and safety of the student and to meet certain legal requirements.  Another goal was to create a single-page document for ease of implementation.   

Attached is the revised School Health Record Face-sheet. When completed, this form, with the student's complete record/certificate of immunizations will become part of the student's school health record.  We would suggest that you consider copying the certificate of immunizations on the back of the School Health Record to ensure that it is included as part of this record.  Or, you may wish to attach the certificate of immunizations to the face-sheet.

If a school district wishes to use a different form or format, this is acceptable, provided the content of the Massachusetts School Health Record Face-Sheet is included. School districts may also wish to add more information pertinent to their student population.

We hope this revised Massachusetts School Health Record form proves useful to you.   Thank you.