[School-nurse] School-nurse Digest, Vol 4, Issue 4

[Dru Roberts]

school-nurse-request at lists.arkansascsh.org wrote:

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>Arkansas Coordinated School Health School Nurse listserv. 
>Digest of today's messages:
>
>Today's Topics:
>
>   1. HIPAA consent (Paula Smith (ADE))
>
>
>----------------------------------------------------------------------
>
>Message: 1
>Date: Tue, 25 Sep 2007 14:44:49 -0500
>From: "Paula Smith \(ADE\)" <Paula.Smith at arkansas.gov>
>Subject: [School-nurse] HIPAA consent
>To: <school-nurse at lists.arkansascsh.org>
>Message-ID:
>	<747B8FABF2CC8343B60112BB7BD53EAF07B591FD at EVS02.sas.arkgov.net>
>Content-Type: text/plain;	charset="iso-8859-1"
>
>Does anyone have an example of a HIPAA consent form they would be willing to share with others? If you are willing to share, please send it to me and I could put it on the web site. Thanks Paula
> 
>Paula Smith, MNSc., RN
>State School Nurse Consultant
>Coordinated School Health
>Arkansas Department of Education
>paula.smith at arkansas.gov
>office 501-683-5758
>fax 501-683-3611
> 
>
>
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>End of School-nurse Digest, Vol 4, Issue 4
>******************************************
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>
>  
>
Paula
     Here is our Hippaa consent  HOPE THIS HELPS!!!!
Dru Roberts,RN
Texarkana Ar.


                                                                         
      SCHOOL HEALTH SERVICES


TO WHOM IT MAY CONCERN:


    I give permission for the school nurse to share medical information 
on my child with his/her teachers, principal, coaches,
and/or other school staffr as needed/  All medical information will be 
kept strictly confidential.

STUDENT NAME______________________________________________________________

ID NUMBER_________________________________________
___________________________________,         
_____________________________________________
SIGNATURE, PARENT OR GUARDIAN            DATE