DPH: Asthma Reporting Forms

 School Reporting   
The State of Connecticut Department of Public Health’s (DPH) Asthma Program has established a statewide system for school-based asthma surveillance based on the school Health Assessment Record (HAR).  Connecticut General Statute (CGS§ 10-206) requires that schools report to the Connecticut Department of Public Health on an annual basis, information on students with asthma.  School nurses will be required to report to the Department of Public Health (DPH) on all students with a provider diagnosis of asthma indicated on the Health Assessment Record.  DPH will use this information to help determine asthma trends and distributions among school-aged children in Connecticut.
Asthma Reporting Forms, School Year 2013-2014

Starting school year 2013-2014, asthma reporting forms will be scanned into a database. Please read the Reporting Form User Guide before downloading the new reporting form.

Reporting Form User Guide {please}                 Asthma Reporting Notice   
                               School Nurse Frequently Asked Questions
Asthma Reporting Form                               
 Electronic form completion requires use of the most current version of Adobe Acrobat Reader.

Content Last Modified on 1/30/2014 11:31:49 AM