In the educational and healthcare ecosystems, the seamless integration of student health information is pivotal for fostering safe and conducive learning environments. Among the numerous documents that facilitate this, Form 708 holds a significant place. Specifically designed for the Hutchinson Public Schools, this physical examination record serves as a comprehensive conduit for capturing essential health metrics for students. Its scope covers the child’s general information including name, age, and parental contacts, an exhaustive checklist of conditions and diseases such as allergies, asthma, diabetes, to name a few, and even inquiries about any previous hospitalizations. It doesn't stop there. The form further delves into the specifics of the medical examination conducted by a healthcare provider, touching upon vital measurements like height, weight, and vision, as well as detailed inspections of bodily systems — from eyes and ears to heart and lungs. Additionally, it solicits information on any limitations on the student's physical activities, thereby ensuring any health concerns are appropriately accommodated in the school setting. Completed with the healthcare provider's insights and laboratory test results, Form 708 emerges as an essential tool in managing and understanding students' health needs, aiming to bridge the gap between educational aspirations and health prerequisites.
| Question | Answer |
|---|---|
| Form Name | Form 708 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 15 |
| Avg. time to fill out | 3 min 34 sec |
| Other names | Childs, Genitalia, OU, HUTCHINSON |
HUTCHINSON PUBLIC SCHOOLS
PHYSICAL EXAMINATION RECORD
Child’s Name ____________________________ Age _____ Date of Birth ________________
Mo Day Year
Parent’s Name ___________________________ Address __________________ Phone _______
Check the following conditions and diseases the child has had: |
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Conditions: |
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Diseases: |
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Allergies |
_____ |
Heart |
_____ |
Chicken Pox |
_____ |
Asthma |
_____ |
Hernia |
_____ |
Rheumatic Fever |
_____ |
Diabetes |
_____ |
Kidney |
_____ |
Scarlet Fever |
_____ |
Epilepsy |
_____ |
Orthopedic |
_____ |
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Has this child ever been hospitalized _______ Why? __________________________________
MEDICAL EXAMINATION BY HEALTH CARE PROVIDER
Height: _____ |
Weight: _____ |
Vision: OD 20/_____ |
OS 20/_____ |
OU 20/_____ |
COMMENTS
Eyes _________________________________________________________________________
Ears _________________________________________________________________________
Nose _________________________________________________________________________
Throat ________________________________________________________________________
Teeth ________________________________________________________________________
Heart _________________________________________________________________________
Lungs ________________________________________________________________________
Skin _________________________________________________________________________
Hernia ________________________________________________________________________
Genitalia ______________________________________________________________________
Orthopedic ____________________________________________________________________
Speech _______________________________________________________________________
LABORATORY TESTS
Hemoglobin ________________________________ U.A. ___________________________
Are there any activities in which this student should not participate?
______________________________________________________________________________
______________________________________________________________________________
Date: __________________________ _____________________________________________
Health Care Provider
Address: _____________________________________
City, State ____________________________________
Phone: ______________________________________
Form 708 Rev. 3/08