NJ Student Health History and Appraisal Report (A45)

Introduction

This report contains student health history information. The report produces a two-page PDF containing vaccination, health screening, and physical examination information for each student for whom the report is run. Vaccines and screenings must be setup at the District Office prior to running the report. Improper setup may lead to unexpected results. For setup information, see Setup for the NJ Student Health History and Appraisal Report.

Selection Criteria

Selection criteria determine which database records are used in the report.

Student Selection

The report selects which student records to use based on the following criteria:

The student must not be excluded from state reporting.
The student must have an immunization or screening record that is not excluded from state reporting.
The student must be enrolled during the report date range.
The student must be enrolled in the selected school if the report is run for a single school or a selection of schools.

Report Input

For help with navigation and running the report, see How to Find and Generate a Report.

Field	Description
Schools to Include	Choose the schools to run the report for. If run at the district level, select one of the following: Select Multiple Schools – Select the schools for which you want to run the report. Includes all student records associated with the selected schools that meet the selection criteria. All Schools – Run the report for all schools in the district. Includes all student records on the PowerSchool server that meet the selection criteria. If run at the school level, the report includes all records associated with the current school that meet the selection criteria. To change the current school, click School at the top of the page and choose the appropriate school from the list.
Students to Include	Select one of the following: The Selected [number] Students Only – Run the report for students in the current selection. All Students – Run the report for all students in the current school or district that meet the selection criteria. Note: If running the report for a single student, or group of students, select the students prior to running report.
Report Start Date	Enter the start date for the reporting period.
Report End Date	Enter the end date for the reporting period.
Run Now	Leave Run Now selected to run the report now.
Schedule	Click the Schedule button to schedule this report to run nightly. Select the weekdays only checkbox.

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Report Output

Each of the fields displayed in the output of the report are described below. See Understanding the Report Output Table for a definition of each column in the table.

Item #	Data Element	Description	[Table]FieldName	Field Length
1	Name of Child (Last, First, Middle)	The student's last name, first name, and middle initial. Note: If populated, the student's legal name overrides the student's preferred name.	[StudentCoreFields]PSCore_Legal_Last_Name [Students]Last_Name [StudentCoreFields]PSCore_Legal_First_Name [Students]First_Name [StudentCoreFields]PSCore_Legal_Middle_Name [Students]Middle_Name	2
2	Student Number	This field contains the number used to identify the student.	[Students]Student_Number	N/A
3	Date of Birth (Month/Day/Year)	The student's date of birth, formatted as month/date/year.	[Students]DOB	N/A
4	Gender	The student's gender. Note: If populated, the student's legal gender overrides the student's preferred gender.	[StudentsCoreFields]PSCore_Legal_Gender [Students]Gender	1
5	Parent or Guardian Name(s)	The name(s) of the student's parent(s)/guardian(s).	[Students]Mother [Students]Father [Students]Guardian_LN [Students]Guardian_FN	60
6	Parent or Guardian Address	The address of the student's parent/guardian.	[Students]Street [Students]City [Students]State [Students]Zip	60 50 2 10
7	Telephone No.	The parent/guardian's telephone number.	[Students]Home_Phone	30
8	Student Immunization Registry Number	The student's Health Identification Number.	[S_STU_X]Health_Identification_Number	N/A
Vaccine Type Each row of the table indicates the vaccine type and the dates that the student received vaccine doses. The columns of the table include the date (month/day/year) that the student received vaccine doses from first dose to fifth dose. If the student did not receive an additional dose for that vaccination, the column is blank for that vaccine. For example, if a student received two doses of varicella, only the boxes for first and second dose are populated.
8	Diptheria, Tetanus, Pertussis (DTaP)	The dates that the student received vaccine doses of DTaP.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
9	Tdap	The dates that the student received vaccine doses of Tdap.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
10	Polio – Inactivated Polio Vaccine (IPV)	The dates that the student received vaccine doses for polio.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
11	Measles, Mumps, Rubella (MMR)	The dates that the student received vaccine doses of MMR.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered [HealthStudDoseRec]TiterMEA [HealthStudDoseRec]TiterRUB [HealthStudDoseRec]TiterMUM	10
12	Haemophilus B (HIB)	The dates that the student received vaccine doses for HIB.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
13	Hepatitis B	The dates that the student received vaccine doses for hepatitis B.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered [HealthStudDoseRec]TiterHEPB	10
14	Varicella	The dates that the student received vaccine doses for varicella.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered [HealthStudDoseRec]TiterVAR	10
15	Pneumococcal Conjugate	The dates that the student received vaccine doses of pneumococcal conjugate.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
16	Meningococcal	The dates that the student received vaccine doses for meningococcal.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
17	Hepatitis A	The dates that the student received vaccine doses for hepatitis A.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
18	HPV (Human Papillomavirus)	The dates that the student received vaccine doses for HPV.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
19	Other: YF	The dates that the student received doses of another vaccine.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
20	Other: BCG	The dates that the student received doses of another vaccine.	[HealthStudImmRec]HealthVaccineID [HealthStudDoseRec]Dose [HealthStudDoseRec]DateAdministered	10
Health Screening Health screening codes: N = Normal R = Referred to a specialist T = Under Treatment C = See Comments This section indicates the student's basic health information based on health screenings. The table contains 15 columns, each documenting the results of a different health screening. The columns are only populated if the student received that number of health screenings. For instance, if the student has only had three health screenings up to the end of the reporting period, only three columns are populated. The rest are blank.
21	Grade / Age	The grade and age of the student on the date of the health screening.	[HealthVitalSigns]GradeLevelAtScreen [Students]DOB	6
22	Screening Date	The date of the health screening.	[HealthVitalSigns]ScreenDate	10
23	Height	The student's height on the date of the health screening.	[HealthVitalSigns]Height	12
24	Weight	The student's weight on the date of the health screening.	[HealthVitalSigns]Weight	12
25	BMI	The student's BMI on the date of the health screening.	[HealthVitalSigns]BMI	12
26	Blood Pressure	The student's systolic and diastolic blood pressure on the date of the health screening.	[HealthVitalSigns]SystolicBloodPressure [HealthVitalSigns]DiastolicBloodPressure	6 6
27	Vision – Right Eye	The results of the student's vision exam for their right eye. See the health screening codes above for valid values.	[HealthStudVision]RightEyeTestLuID [HealthStudVision]VisionScreenOutcomeLuID [HealthScreenLookup]StateReportCode [HealthStudVision]ScreenComment [HealthStudVision]VisionScreeningWithCorrection [HealthStudVision]VisionScreeningWithoutCorrection [HealthStudVision]VisionScreeningMuscleBalanceResults	1
28	Vision – Left Eye	The results of the student's vision exam for their left eye. See the health screening codes above for valid values.	[HealthStudVision]LeftEyeTestLuID [HealthStudVision]VisionScreenOutcomeLuID [HealthScreenLookup]StateReportCode [HealthStudVision]ScreenComment [HealthStudVision]VisionScreeningWithCorrection [HealthStudVision]VisionScreeningWithoutCorrection [HealthStudVision]VisionScreeningMuscleBalanceResults	1

29	Color Perception Date	The date the student took a color perception screening. Note: The student takes this screening only once, so this row does not have multiple columns.	[HealthStudVision]ColorBlindTestLuID [HealthStudVision]ScreenDate [HealthScreenLookup]StateReportCode	10
29	Color Perception Result	The result of the student's color perception screening See the health screening codes above for valid values.	[HealthStudVision]ColorBlindTestLuID [HealthStudVision]VisionScreenOutcomeLuID [HealthScreenLookup]StateReportCode [HealthStudVision]ScreenComment	1
30	Hearing Screening Date	The date of the student's hearing screening.	[HealthStudHearing]ScreenDate	10
31	Hearing – Right Ear	The results of the student's hearing exam for their right ear. See the health screening codes above for valid values.	[HealthStudHearing]RightEarTestLuID [HealthStudHearing]HearingScreenOutcomeLuID [HealthScreenLookup]StateReportCode [HealthStudHearing]ScreenComment	1
32	Hearing – Left Ear	The results of the student's hearing exam for their right eye. See the health screening codes above for valid values.	[HealthStudHearing]LeftEarTestLuID [HealthStudHearing]HearingScreenOutcomeLuID [HealthScreenLookup]StateReportCode [HealthStudHearing]ScreenComment	1
33	Biennial Scoliosis Screening (Beginning at Age 10)	The dates the student took a scoliosis screening. The screenings are done every two years beginning when the student is ten years old.	[HealthStudScolio]ScreenDate	10
34	Referred for Abnormal Result	If the student was referred to a specialist due to an abnormal result of the scoliosis screening on that date, this field is populated with an X.	[HealthStudScolio]ScolioScreenOutcomeLuID [HealthScreenLookup]StateReportCode	1
TB Screening (Mantoux or IGRA Test) This section is required for students enrolled in day care/child care, from the time the student is 2 months old to the student's fifth birthday. This section contains two columns for up to two screenings.
35	Tested	The date(s) the student was tested.	[HealthStudTB]ScreenDate	10
36	Read	The date(s) the test was read.	[HealthStudTB]SkinTestReadDate	10
37	Mantoux Result (mm)	The result of the Mantoux skin test.	[HealthStudTB]SkinTestTypeLUID [HealthStudTB]ImpressionResultLUID [HealthScreenLookup]StateReportCode	1
38	IGRA Result	The result of the IGRA skin test.	[HealthStudTB]SkinTestTypeLUID [HealthStudTB]ImpressionResultLUID [HealthScreenLookup]StateReportCode	10
39	Chest X-Ray Film Date	The date on which chest X-ray film date	[HealthStudTB]ChestX-rayFilmDate	10
40	Chest X-Ray Impression	N- Normal A- Abnormal	[HealthStudTB]ChestX-rayImpression	10
Medication This section indicates the most recent medication recorded for the student as recorded in the PowerSchool Advanced Health Module. If multiple medications have the same start date, the most recently created record is selected. If there are no medications entered in PowerSchool, this section will remain blank.
39	Medication	The name of the medication the student takes, if applicable.	Health Medication Module	7
40	Date Started	The second medication the student takes, if applicable.	Health Medication Module - Start Date	Date
41	Date Completed	The third medication the student takes, if applicable.	Health Medication Module - End Date	Date
Physical Examinations This section includes any physical examinations that the student took. Each row contains information for one physical. The section should be entered manually and is not populated by the PowerSchool system.
42	Date	The date of the physical exam.	Health Physical Exam Module - Date	Date
43	Grade/Age	The student's grade and age on the date of the exam.	Health Physical Exam Module - Grade	2
44	Type of Exam	The type of physical exam.	Manual Entry	N/A
45	Significant Findings	Any significant findings based on the physical exam.	Health Physical Exam Module - Referral	100
46	Medical Provider	The medical provider of the physical exam.	Health Physical Exam Module - Examiner	20

47	Date	The date of the examination.	same as above	Date
48	Comments	The findings and recommendations were made by the physician. This may include recommendations for medications; operations or injuries; modifications to the school program; referrals and follow-ups; conferences with parents or teachers; counseling with the student. Please attach the individual nurse's notes.	Health Physical Exam Module - Comments	500
49	Signature	The physician's/nurse's signature.	Manual Entry	N/A

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