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Understanding the intricacies and requirements embedded in the Health Assessment Record, known as the Har 3 Connecticut form, necessitates a comprehensive review of its two-part structure, aimed at ensuring children’s readiness for school and participation in sports throughout the state. Specified by the State of Connecticut Department of Education, this form serves a pivotal role in gathering crucial health information, thereby facilitating a nurturing and safe educational environment. Parents or guardians fill out the first section, providing valuable health history and current health status information about their child. This assists healthcare providers in completing the second part, which involves a detailed medical evaluation. Mandatory under state laws (C.G.S. Secs. 10-204a and 10-206), the completion of this form requires up-to-date immunizations and a thorough health assessment by a qualified health professional before a child’s admission into any Connecticut school. Beyond initial school entry, the form is integral for those entering the 6th or 7th grades and the 9th or 10th grades, with specific requirements set by the local board of education. Additionally, it is requisitioned annually for students engaged in sports, ensuring ongoing health monitoring. Embedded within this process is the implicit goal of fostering an educational setting that is responsive to the health needs of its students, thus optimizing their learning potential and overall school experience.

Document Sample

State of Connecticut Department of Education

Health Assessment Record

To Parent or Guardian:

In order to provide the best educational experience, school personnel must understand your child’s health needs. This form requests information from you (Part I) which will also be helpful to the health care provider when he or she completes the medical evaluation (Part II).

State law requires complete primary immunizations and a health assessment by a legally qualiied practitioner of medicine, an advanced

practice registered nurse or registered nurse, a physician assistant or the school medical advisor prior to school entrance in Connecticut (C.G.S.

Secs. 10-204a and 10-206). An immunization update and additional health assessments are required in the 6th or 7th grade and in the 9th or 10th grade. Speciic grade level will be determined by the local board of education. This form may also be used for health assessments required

every year for students participating on sports teams.

Please print

Student Name (Last, First, Middle)

Birth Date

 

❑ Male ❑ Female

 

 

 

 

 

Address (Street, Town and ZIP code)

 

 

 

 

 

 

 

 

 

Parent/Guardian Name (Last, First, Middle)

Home Phone

 

Cell Phone

 

 

 

School/Grade

Race/Ethnicity

❑ Black, not of Hispanic origin

 

❑ American Indian/

❑ White, not of Hispanic origin

 

Alaskan Native

❑ Asian/Paciic Islander

Primary Care Provider

 

❑ Hispanic/Latino

❑ Other

 

 

 

 

 

Health Insurance Company/Number* or Medicaid/Number*

Does your child have health insurance?

Y

N

If your child does not have health insurance, call 1-877-CT-HUSKY

Does your child have dental insurance?

Y

N

 

 

 

 

 

* If applicable

 

 

 

Part I — To be completed by parent/guardian.

Please answer these health history questions about your child before the physical examination.

Please circle Y if “yes” or N if “no.” Explain all “yes” answers in the space provided below.

Any health concerns

Y

N

Hospitalization or Emergency Room visit Y

N

Concussion

Y

N

Allergies to food or bee stings

Y

N

Any broken bones or dislocations

Y

N

Fainting or blacking out

Y

N

Allergies to medication

Y

N

Any muscle or joint injuries

Y

N

Chest pain

Y

N

Any other allergies

Y

N

Any neck or back injuries

Y

N

Heart problems

Y

N

Any daily medications

Y

N

Problems running

Y

N

High blood pressure

Y

N

Any problems with vision

Y

N

“Mono” (past 1 year)

Y

N

Bleeding more than expected

Y

N

Uses contacts or glasses

Y

N

Has only 1 kidney or testicle

Y

N

Problems breathing or coughing

Y

N

 

 

 

 

 

 

 

 

 

Any problems hearing

Y

N

Excessive weight gain/loss

Y

N

Any smoking

Y

N

Any problems with speech

Y

N

Dental braces, caps, or bridges

Y

N

Asthma treatment (past 3 years)

Y

N

 

 

 

 

 

 

 

 

 

Family History

 

 

 

 

 

Seizure treatment (past 2 years)

Y

N

Any relative ever have a sudden unexplained death (less than 50 years old)

Y

N

Diabetes

Y

N

 

 

 

 

 

 

Any immediate family members have high cholesterol

Y

N

ADHD/ADD

Y

N

 

 

 

 

 

 

 

 

 

Please explain all “yes” answers here. For illnesses/injuries/etc., include the year and/or your child’s age at the time.

Is there anything you want to discuss with the school nurse? Y N If yes, explain:

Please list any medications your child will need to take in school:

All medications taken in school require a separate Medication Authorization Form signed by a health care provider and parent/guardian.

I give permission for release and exchange of information on this form between the school nurse and health care provider for conidential

use in meeting my child’s health and educational needs in school. Signature of Parent/Guardian

Date

 

 

HAR-3 REV. 4/2011

TO BE MAINTAINED IN THE STUDENT’S CUMULATIVE SCHOOL HEALTH RECORD

Part II — Medical Evaluation

HAR-3 REV. 4/2011

Health Care Provider must complete and sign the medical evaluation and physical examination

Student Name

 

Birth Date

 

Date of Exam

❑I have reviewed the health history information provided in Part I of this form

Physical Exam

Note: *Mandated Screening/Test to be completed by provider under Connecticut State Law

*Height _____ in. / _____% *Weight _____ lbs. / _____%

BMI _____ / _____% Pulse _____

*Blood Pressure _____ / _____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Normal

 

Describe Abnormal

 

 

Ortho

 

 

Normal

 

Describe Abnormal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neurologic

 

 

 

 

 

 

Neck

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEENT

 

 

 

 

 

 

Shoulders

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Gross Dental

 

 

 

 

 

 

Arms/Hands

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lymphatic

 

 

 

 

 

 

Hips

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart

 

 

 

 

 

 

Knees

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lungs

 

 

 

 

 

 

Feet/Ankles

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Abdomen

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Postural

❑ No spinal

❑ Spine abnormality:

 

 

 

 

 

 

 

 

Genitalia/ hernia

 

 

 

 

 

 

 

 

abnormality

 

❑ Mild

❑ Moderate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❑ Marked ❑ Referral made

Skin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Screenings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Vision Screening

 

 

 

*Auditory Screening

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

Type:

Right

Left

 

Type:

Right

Left

 

 

Lead:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❑ Pass

❑ Pass

 

 

 

 

 

 

 

With glasses

20/

20/

 

 

 

 

*HCT/HGB:

 

 

 

 

 

 

 

 

 

 

❑ Fail

❑ Fail

 

 

 

 

 

 

 

 

 

Without glasses

20/

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Speech (school entry only)

 

 

 

 

 

 

 

 

 

 

 

 

 

❑ Referral made

 

 

 

❑ Referral made

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TB: High-risk group?

❑ No

❑ Yes

 

PPD date read:

 

 

Results:

 

 

 

Treatment:

 

 

 

*IMMUNIZATIONS

❑Up to Date or ❑ Catch-up Schedule: MUST HAVE IMMUNIZATION RECORD ATTACHED

*Chronic Disease Assessment:

Asthma

❑ No

❑ Yes:

❑ Intermittent ❑ Mild Persistent ❑ Moderate Persistent ❑ Severe Persistent ❑ Exercise induced

 

If yes, please provide a copy of the Asthma Action Plan to School

 

Anaphylaxis ❑ No

❑ Yes:

❑ Food

❑ Insects

❑ Latex

❑ Unknown source

 

Allergies

If yes, please provide a copy of the Emergency Allergy Plan to School

 

 

History of Anaphylaxis

❑ No

❑ Yes

Epi Pen required ❑ No

❑ Yes

Diabetes

❑ No

❑ Yes:

❑ Type I

❑ Type II

Other Chronic Disease:

 

Seizures

❑ No

❑ Yes, type:

 

 

 

 

❑This student has a developmental, emotional, behavioral or psychiatric condition that may affect his or her educational experience. Explain: ____________________________________________________________________________________________________

Daily Medications (specify): ____________________________________________________________________________________

This student may: ❑ participate fully in the school program

❑participate in the school program with the following restriction/adaptation: _____________________________

___________________________________________________________________________________________________________

This student may: ❑ participate fully in athletic activities and competitive sports

❑participate in athletic activities and competitive sports with the following restriction/adaptation: ____________

___________________________________________________________________________________________________________

❑Yes ❑ No Based on this comprehensive health history and physical examination, this student has maintained his/her level of wellness.

Is this the student’s medical home? ❑ Yes ❑ No ❑ I would like to discuss information in this report with the school nurse.

 

 

 

 

 

 

Signature of health care provider MD / DO / APRN / PA

Date Signed

Printed/Stamped Provider Name and Phone Number

 

 

 

 

 

Student Name: ______________________________________ Birth Date: ___________________

Immunization Record

To the Health Care Provider: Please complete and initial below.

HAR-3 REV. 4/2011

Vaccine (Month/Day/Year) Note: *Minimum requirements prior to school enrollment. At subsequent exams, note booster shots only.

 

Dose 1

Dose 2

 

Dose 3

 

Dose 4

 

Dose 5

 

Dose 6

 

 

 

 

 

 

 

 

 

 

 

 

 

DTP/DTaP

*

*

 

*

 

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DT/Td

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tdap

*

 

 

 

 

 

 

Required for 7th grade entry

 

 

 

 

 

 

 

 

 

 

 

 

 

IPV/OPV

*

*

 

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MMR

*

*

 

 

 

 

 

Required K-12th grade

 

 

 

 

 

 

 

 

 

 

 

Measles

*

*

 

 

 

 

 

Required K-12th grade

 

 

 

 

 

 

 

 

 

 

 

Mumps

*

*

 

 

 

 

 

Required K-12th grade

 

 

 

 

 

 

 

 

 

 

 

Rubella

*

*

 

 

 

 

 

Required K-12th grade

 

 

 

 

 

 

 

 

 

 

 

HIB

*

 

 

 

 

 

 

PK and K (Students under age 5)

 

 

 

 

 

 

 

 

 

 

 

Hep A

*

*

 

 

 

 

 

PK and K (born 1/1/2007 or later)

 

 

 

 

 

 

 

 

 

 

 

Hep B

*

*

 

*

 

 

 

Required PK-12th grade

 

 

 

 

 

 

 

 

 

 

 

Varicella

*

*

 

 

 

 

 

2 doses required for K & 7th grade as of 8/1/2011

 

 

 

 

 

 

 

 

 

 

 

 

PCV

*

 

 

 

 

 

 

PK and K (born 1/1/2007 or later)

 

 

 

 

 

 

 

 

 

 

 

Meningococcal

*

 

 

 

 

 

 

Required for 7th grade entry

 

 

 

 

 

 

 

 

 

 

 

 

 

HPV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Flu

*

 

 

 

 

 

 

PK students 24-59 months old – given annually

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disease Hx ________________________________

________________________________

________________________________

 

 

of above

(Specify)

 

 

(Date)

 

 

 

(Conirmed by)

 

 

 

 

 

 

 

Exemption

 

 

 

 

 

 

 

 

 

Religious _____ Medical: Permanent _____

Temporary _____ Date _____

 

 

 

 

Recertify Date _________

Recertify Date _________ Recertify Date ________

 

 

 

Immunization Requirements for Newly Enrolled Students at Connecticut Schools

KINDERGARTEN

•DTaP: At least 4 doses. The last dose must be given on or after 4th birthday.

•Polio: At least 3 doses. The last dose must be given on or after 4th birthday.

•MMR: 2 doses given at least 28 day apart – 1st dose on or after the 1st birthday.

•Hib: 1 dose on or after 1st birthday (Children 5 years and older do not need proof of Hib vaccination).

•Pneumococcal: 1 dose on or after 1st birthday (born 1/1/2007 or later and less than 5 years old).

•Hep A: 2 doses given six months apart-1st dose on or after 1st birthday.

•Hep B: 3 doses-the last dose on or after 24 weeks of age.

•Varicella: For students enrolled before August 1, 2011, 1 dose given on or after 1st birthday; for students enrolled on or after August 1, 2011

2 doses given 3 months apart – 1st dose on or after 1st birthday or veriication of disease*.

GRADES 1-6

•DTaP /Td/Tdap: At least 4 doses. The last dose must be given on or after 4th birthday;

students who start the series at age 7 or older only need a total of 3 doses of tetanus-diphtheria containing vaccine.

•Polio: At least 3 doses. The last dose must be given on or after 4th birthday.

•MMR: 2 doses given at least 28 days apart- 1st dose on or after the 1st birthday.

•Hep B: 3 doses – the last dose on or after 24 weeks of age.

•Varicella: 1 dose on or after the 1st birthday or veriication of disease*.

GRADE 7

•Tdap/Td: 1 dose of Tdap for students 11 yrs. or older enrolled in 7th grade who completed their primary DTaP series; For those students who start the series at age 7 or older a total of 3 doses of tetanus-diphtheria containing vac- cines are needed, one of which must be Tdap.

•Polio: At least 3 doses. The last dose must be given on or after 4th birthday.

•MMR: 2 doses given at least 28 days apart – 1st dose on or after the 1st birthday.

•Meningococcal: one dose for students enrolled in 7th grade.

•Hep B: 3 doses-the last dose on or after 24 weeks of age.

•Varicella: 2 doses given 3 months apart – 1st dose on or after 1st birthday or veriication of

disease*.

GRADES 8-12

•Td: At least 3 doses. Students who start the series at age 7 or older only need a total of 3 doses of tetanus-diphtheria containing vaccine one of which should be Tdap.

•Polio: At least 3 doses. The last dose must be given on or after 4th birthday.

•MMR: 2 doses given at least 28 days apart- 1st dose on or after the 1st birthday.

•Hep B: 3 doses-the last dose on or after 24 weeks of age.

•Varicella: For students <13 years of age, 1 dose given on or after the 1st birthday. For

students 13 years of age or older, 2 doses given at least 4 weeks apart or veriication of

disease*.

*Veriicationofdisease:Conirmation in writ- ing by a MD, PA, or APRN that the child has a previous history of disease, based on family or medical history.

 

 

 

 

 

 

Initial/Signature of health care provider MD / DO / APRN / PA

Date Signed

Printed/Stamped Provider Name and Phone Number

 

 

 

 

 
Click for Har 3 Connecticut PDF

Document Overview

Fact Name Description
Governing Laws Connecticut General Statutes Secs. 10-204a and 10-206 govern the requirements for primary immunizations and health assessments for school entrance in Connecticut.
Purpose The form is designed to inform school personnel of a student's health needs to provide the best educational experience.
Components The form consists of Part I, which is completed by the parent or guardian, and Part II, completed by a healthcare provider.
Immunization and Health Assessment Intervals Immunization updates and additional health assessments are required in the 6th or 7th grade and again in the 9th or 10th grade. Specific grade levels are determined by the local board of education.
Sports Participation This form is also used for yearly health assessments required for students participating in sports teams.
Immunization Record Attachment A complete immunization record must be attached for the form to be valid. This includes documenting both mandatory and booster doses as required.
Consent for Information Release Part I includes a section for parent/guardian consent for the release and exchange of the form's information between the school nurse and health care provider.
Chronic Disease Assessment Part II of the form allows health care providers to note any chronic diseases such as asthma, diabetes, allergies, etc., and to provide a copy of any action plans to the school.

Instructions on How to Fill Out Har 3 Connecticut

Filling out the HAR-3 Connecticut Health Assessment Record is a crucial step in ensuring that a child's health needs are understood and met in an educational environment. This form is divided into two main parts. Part I is for the parent or guardian to complete, providing valuable health history information about the child. Part II is a detailed medical evaluation that must be filled out by a qualified health care provider. The process might seem daunting at first, but with clear, step-by-step instructions, you can accurately complete the form to comply with the state's health assessment requirements for school entry and participation in sports teams.

  1. Part I - To be completed by parent/guardian:
    1. Print the student's name, birth date, address, and other personal information at the top of the form.
    2. Indicate the student's race/ethnicity by checking the appropriate box.
    3. Fill in the Primary Care Provider's name and the health insurance company/number, if applicable.
    4. Answer "Yes" or "No" to the health history questions provided. Explain any "Yes" answers in the space given.
    5. List any medications the child will need to take in school and note that a separate Medication Authorization Form is required for each.
    6. Sign and date the form at the bottom of Part I to give permission for the exchange of health information between the school nurse and the health care provider.
  2. Part II - Medical Evaluation (To be completed by health care provider):
    1. The health care provider must review the health history information in Part I before performing the examination.
    2. Complete the physical exam section, noting any abnormal findings.
    3. Complete the mandated screenings/tests section as required under Connecticut State Law, including vision and auditory screenings.
    4. Fill out the Immunizations section and attach the Immunization Record. Initial any applicable boxes to confirm the student's immunization status.
    5. Assess and document any chronic disease information, such as asthma or diabetes, and provide copies of action plans as required.
    6. Indicate whether the student can participate fully in the school program and athletic activities or if there are any restrictions/adaptations.
    7. Confirm whether the student has maintained their level of wellness based on the comprehensive health history and physical examination.
    8. Sign and date the form, including the printed/stamped provider name and phone number.

After both parts of the HAR-3 form are completed, ensure that all necessary documents, such as the Immunization Record and any action plans for chronic conditions, are attached. Submit the form and attachments to the appropriate school official to fulfill the health assessment requirements. This will help ensure that your child receives the best educational experience tailored to their health needs.

More About Har 3 Connecticut

Frequently Asked Questions about the HAR-3 Connecticut Health Assessment Record

  1. What is the purpose of the HAR-3 Connecticut Health Assessment Record?

    The HAR-3 Connecticut Health Assessment Record is designed to ensure that school personnel are fully informed about a student's health needs to provide the best educational experience. It includes health history information provided by the parent or guardian and results from a medical evaluation performed by a healthcare provider.

  2. Who needs to complete the HAR-3 form?

    The HAR-3 form must be completed for students entering school in Connecticut for the first time, and updated in 6th or 7th grade and again in 9th or 10th grade. Furthermore, students who participate in sports teams are required to have an updated health assessment each year.

  3. What are the sections of the HAR-3 form?

    The HAR-3 form is divided into two main parts. Part I must be completed by the parent or guardian and provides the student’s health history. Part II is a medical evaluation that must be filled out and signed by a healthcare provider.

  4. What information is required from parents or guardians in Part I?

    In Part I, parents or guardians are asked to provide information on their child's health history, including hospitalizations, allergies, medications, and any chronic conditions. This section also requests permission for the exchange of information between the school nurse and the healthcare provider.

  5. What does Part II involve?

    Part II is a comprehensive medical evaluation performed by a healthcare provider. It includes mandated screenings/tests under Connecticut State Law such as vision and auditory screenings, immunization updates, and assessments for chronic diseases like asthma or diabetes.

  6. Are immunizations required for school entrance in Connecticut?

    Yes, state law requires that all students have complete primary immunizations before entering school in Connecticut. The HAR-3 form requires an attached immunization record to be submitted with the health assessment.

  7. What happens if a student doesn't have health insurance?

    If a child does not have health insurance, parents or guardians are encouraged to contact HUSKY Health for assistance. HUSKY Health provides a comprehensive health insurance program for Connecticut's children.

  8. Can the HAR-3 form be used for any grade level?

    Yes, the HAR-3 form is adaptable for use across various grade levels as specified by the Connecticut Department of Education. It is specifically required for new school entrants, students at transitional grades like 6th or 7th and 9th or 10th, and for annual sports participation.

Common mistakes

When filling out the Har 3 Connecticut health form, people often make mistakes that can lead to incomplete or inaccurate information being recorded. These mistakes can affect the health care and educational support a student receives, so it's important to complete the form carefully. Here are six common errors:

  1. Not reviewing Part I thoroughly before the medical exam: Part I of the form is intended for the parent or guardian to fill out, providing essential health history information. This part of the form should be reviewed and filled in completely to ensure the health care provider has all the necessary background information to conduct a comprehensive medical evaluation in Part II.
  2. Skipping the explanation of "yes" answers: When a question in Part I is answered with "yes," an explanation is required. Failing to provide details can leave significant health concerns unaddressed, as the health care provider might miss key information needed to provide appropriate care or recommendations.
  3. Incomplete immunization records: The form requires up-to-date immunization records, including dates and types of vaccines administered. Forgetting to attach a copy of the immunization record or failing to fill in all required vaccine information leads to delays in school enrollment or participation in sports.
  4. Overlooking the consent signature: At the end of Part I, a parent/guardian’s signature is required to authorize the release and exchange of medical information between the school nurse and the health care provider. Not signing this section can hinder the necessary communication regarding the student's health needs.
  5. Missing the health care provider's signature and credentials in Part II: The health assessment must be completed and signed by a legally qualified health care provider. Omitting the provider's signature, credentials (MD, DO, APRN, PA), and contact information can invalidate the form, as it fails to verify the authenticity of the medical evaluation.
  6. Not specifying restrictions or adaptations for school or sports: If the student requires any restrictions or adaptations to fully participate in school activities or sports, these must be clearly indicated by the health care provider. Neglecting to specify these recommendations can lead to inadequate support or accommodations for the student.

Addressing these common mistakes can streamline the health assessment process, ensuring students receive the necessary care and support in their educational environment. Always double-check the form for completeness and accuracy before submission.

Documents used along the form

When completing the HAR-3 Connecticut Health Assessment Record, a comprehensive understanding of the child's health is crucial for ensuring they receive appropriate care and attention in the educational setting. To achieve this, several other documents may be required in conjunction with the HAR-3 form to provide a full picture of the child's health status. Here is a list of documents that are often used together with the HAR-3 form for a holistic approach to a student's health assessment in Connecticut schools.

  1. Immunization Record: Detailed documentation of all vaccines received by the student, including dates and types of vaccines, to ensure compliance with state immunization requirements.
  2. Medication Authorization Form: This form is necessary if the child needs to take medication while at school, detailing the medication, dosage, and permission from both parents/guardians and a healthcare provider.
  3. Asthma Action Plan: For students with asthma, this form outlines the management of the condition, including triggers, treatment plans, and emergency procedures.
  4. Emergency Allergy Action Plan: For students with severe allergies, this document specifies the allergens, symptoms of an allergic reaction, and the steps to take in case of an emergency.
  5. Seizure Action Plan: If the student has seizures, this plan provides a detailed approach to managing seizures at school, including medications, first aid steps, and when to call for emergency help.
  • Physical Examination Form: Completed by a healthcare provider, it provides comprehensive details about the student's physical health beyond the initial HAR-3 assessment.
  • Vision Examination Report: Details on the student's vision capabilities and any corrective measures, such as glasses or contact lenses, that are needed.
  • Hearing Screening Report: Documents the results of a hearing test to identify any hearing loss or issues that could affect the student's learning.
  • Dental Health Assessment: A report of the student's dental health status, identifying any potential issues like cavities or gum disease that may require treatment.
  • Special Education Documents: For students with special educational needs, relevant documents that detail accommodations, Individualized Education Programs (IEP), or 504 Plans that support the student's learning.

    • Collecting and reviewing these documents in conjunction with the HAR-3 form allows school health professionals to create a supportive and safe learning environment tailored to each student's unique needs. Ensailing that all necessary health information is accurately captured and addressed promotes not only the well-being of the student but also enhances their ability to engage and succeed in the educational setting.

    Similar forms

    The Har 3 Connecticut form is similar to other health assessment and immunization forms used across various states for school enrollment and participation in sports. These documents share a common goal: ensuring that students meet health standards necessary for their own safety and the well-being of others in the education system.

    One document similar to the Har 3 Connecticut form is the Universal Child Health Record used in New Jersey. Just like the Har 3 form, this record collects detailed health information from a child’s primary care provider, including immunizations, physical examinations, and a comprehensive health history. Both forms are designed to be completed in parts by both the parent or guardian and a healthcare professional. They play a crucial role in identifying health issues that could impact a child's educational experience and require that immunization records be attached or summarized to ensure compliance with state laws.

    Another related document is the School Entrance Health Form used in Virginia. This form also requires completion by both the child's parent or guardian and a healthcare provider. It includes sections for documenting the child's comprehensive physical examination, immunization record, and tuberculosis screening history, much like the Har 3 form. Additionally, it mandates reporting of specific health conditions that could affect the child's school experience, such as chronic diseases or allergies, and like the Har 3, it emphasizes the importance of understanding a child's health needs to provide the best educational experience.

    Lastly, the State of Illinois Certificate of Child Health Examination is quite comparable to the Har 3 form with its detailed health history section, complete immunization documentation, and a record of physical examination findings required before school entrance and at certain grade levels. Despite the differences in state-specific vaccine requirements and health assessment schedules, both forms ensure students receive appropriate health evaluations, aid in the management of potential health problems within the school setting, and promote a safe and healthy educational environment. These similarities underline the universal goal across states to maintain high standards of health and wellness in their schools.

    Dos and Don'ts

    Filling out the Connecticut Department of Education Health Assessment Record (HAR-3) is a critical process that ensures schools are aware of and can adequately support the health needs of students. To help navigate this important task, here are some dos and don'ts to consider:

    • Do ensure all information provided is current and accurate. This includes updating any recent medical appointments, assessments, or changes in health status.
    • Do complete both Part I by the parent/guardian and Part II by a health care provider. Each section collects vital information for a comprehensive understanding of the child's health needs.
    • Do attach the required Immunization Record. This is crucial for verifying the student's immunization status against Connecticut's school immunization requirements.
    • Do thoroughly explain any "yes" responses in the health history section, providing specifics such as dates, conditions, and outcomes. This detail assists school health personnel in providing appropriate care and support.
    • Do list all medications the child needs to take during school hours and remember to submit a separate Medication Authorization Form for each, as required.
    • Do not leave sections incomplete. Incomplete information may delay the student’s school entry or participation in school activities.
    • Do not forget to sign and date the form. The parent/guardian's signature authorizes the release and exchange of medical information between the school nurse and the health care provider.

    Approaching the HAR-3 form with diligence and attention to detail ensures that all necessary health information is accurately communicated to the school. This fosters a supportive environment conducive to the student's educational and health needs.

    Misconceptions

    When discussing the State of Connecticut Department of Education Health Assessment Record, often referred to as the Har 3 Connecticut form, several misconceptions can occur due to its comprehensive and detailed nature. Understanding the correct information is crucial for parents, guardians, and students to comply appropriately with state laws and school policies. Below are eight common misconceptions about the Har 3 form and their explanations:

    • It's only for new students: A common misconception is that the Har 3 form is only required for students who are newly enrolling in a Connecticut school. However, this form is necessary for all students at specific grade levels, not just new enrollees. Additionally, it must be updated for sports participation and when reaching certain grade milestones.

    • Any health care provider can complete Part II: Though many health care professionals can offer valuable insights into a child's health, Connecticut State Law specifies that only a legally qualified practitioner of medicine, an advanced practice registered nurse, a registered nurse, a physician assistant, or the school medical advisor can complete the medical evaluation in Part II of the form.

    • Immunizations aren’t mandatory if the form is filled out: Despite completing the Har 3 form, students must meet all the state's primary immunization requirements before school entrance, with updates required at later grades. Omitting this critical requirement can lead to non-compliance with the state law.

    • The form is only about physical health: While the Har 3 form includes a detailed physical examination, it also requires a comprehensive health history that covers allergies, hospitalizations, medications, and more. This broader health picture helps ensure that students receive appropriate care while at school.

    • Submission of the form guarantees sports eligibility: Although the form is required for students participating in sports, simply submitting it does not automatically qualify a student for athletic activities. The medical evaluation may indicate health conditions that warrant restrictions or adaptations for safe participation.

    • Dental insurance information is optional: While not directly related to the health assessment's medical portion, providing information about dental insurance is essential. This part of the form helps ensure that children have access to dental care, which is vital for overall health.

    • Part I of the form is for the health care provider’s use only: Actually, Part I is designed to be completed by the parent or guardian. It gathers relevant health history information that can guide the health care provider during the medical evaluation in Part II.

    • Older versions of the form are still acceptable: The State of Connecticut periodically updates the Har 3 form to reflect current health standards and immunization requirements. Therefore, it's essential to use the latest revision of the form to ensure compliance with current state laws and guidelines.

    Understanding these aspects of the Har 3 Connecticut form can help ensure that the necessary procedures are correctly followed for the health and safety of students within the school system.

    Key takeaways

    When filling out and using the HAR-3 Connecticut Health Assessment Record for school registration, it's important to understand and follow these key points:

    • Ensure that Part I is completed by the parent or guardian. This section gathers vital health history information about the student that is crucial for accurate assessment and care planning.
    • State law mandates that all students entering Connecticut schools have complete primary immunizations, as well as a health assessment by a qualified practitioner before their school entrance.
    • The HAR-3 form is also required for sports team participation annually, in addition to the health assessments needed in the 6th or 7th grade and again in the 9th or 10th grade.
    • If your child does not have health insurance, the form reminds and encourages you to contact 1-877-CT-HUSKY for assistance.
    • Any "yes" answers in the health history section of Part I must be explained in detail to provide the health care provider with a comprehensive overview of the student's health status.
    • All medications that will be administered at school require a separate Medication Authorization Form, which must be signed by both a health care provider and the parent/guardian.
    • Part II must be completed and signed by a licensed health care provider, which includes a detailed medical evaluation and physical examination of the student.
    • Mandated screenings/tests such as vision, auditory, and postural screenings, are highlighted to ensure compliance with Connecticut State Law.
    • Immunization records must be attached to the HAR-3 form, clearly documenting the student's adherence to state immunization requirements for school entry and continued enrollment.
    • In the event of a medical or religious exemption from immunizations, the form requires specific details including the type of exemption and applicable dates for recertification.
    • The form allows for a discussion section for any developmental, emotional, behavioral, or psychiatric condition that may affect the student's educational experience, ensuring a holistic approach to the child's well-being.
    • The health care provider's assessment of whether the student can participate in the school program or athletic activities without restrictions, or if any adaptations are necessary, is crucial for safeguarding the student's health during school activities.

    By diligently completing and using the HAR-3 Connecticut Health Assessment Record, parents, guardians, and health care providers work together to ensure that students receive the care and support they need for a successful and healthy school experience.

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