Physical Health Sexual/Reproductive Health Behavioral Health Dental Abdominal Pain Treatment Contraceptive Counseling/FP Advice Assessment/Intake Case Management Asthma Counseling/Treatment Contraceptive Maintenance Brokerage/Referral Diagnostic Services (X-Rays) Cold/Flu Symptom Treatment Emergency Contraception Case Management Preventive (Fluoride/Cleaning) Diabetes Counseling/Treatment GYN Exam/Family Planning Annual Classroom Observation/Support Restorative Services Dysmenorrhea Treatment HIV Screening/Counseling Collateral – Family Screening/Assessment/ General Health Counseling Pregnancy Counseling Collateral – School Staff Examination Headache Treatment Pregnancy Test/Exam – Negative Collateral – Other Sealants Immunization/Vaccination Pregnancy Test/Exam - Positive Conflict Resolution Other Dental Injury Treatment STI Screening/Counseling Crisis Intervention Irregular Menses Treatment STI Test/Exam – Negative Family Therapy Lab Results Review (Non-Billable) STI Test/Exam - Positive Individual Contact/Meeting Group Services Nutrition/Diet/Exercise Counseling Other Sexual/Reproductive Health Individual Therapy Behavioral Health Overweight/Obesity Counseling Plan Development Restorative Justice Psychosocial Screening Student Success Team/IEP Health Education School/Sports Exam Other Behavioral Health Medical Well Exams Other Physical Health External Referrals/Follow-Up (outside SHC) (check all that apply) After Visit (check one) None Needed Primary Care Provider/Medical Home Sent Back to Class/Recess/Lunch Other Behavioral Health Other Medical Provider/Clinic Sent Home (During School Day) N/A Dental School Support Services Ambulance Insurance Screening/Enrollment Other ICD-9 Code Description V20.2 Routine infant or child health check V70.0 Routine general medical examination at a health care facility V70.3 Other general medical examination for administrative purposes V70.5 Health examination of defined subpopulations (for example, students) V70.6 Health examination in population surveys V70.8 Other specified general medical examinations V70.9 Unspecified general medical examination
Physical Health Abdominal Pain Treatment Asthma Counseling/Treatment Cold/Flu Symptom Treatment Diabetes Counseling/Treatment Dysmenorrhea Treatment General Health Counseling Headache Treatment Immunization/Vaccination Injury Treatment Irregular Menses Treatment Lab Results Review (Non-Billable) Nutrition/Diet/Exercise Counseling Overweight/Obesity Counseling Psychosocial Screening School/Sports Exam Well Exams Other Physical Health Sexual/Reproductive Health Contraceptive Counseling/FP Advice Contraceptive Maintenance Emergency Contraception GYN Exam/Family Planning Annual HIV Screening/Counseling Pregnancy Counseling Pregnancy Test/Exam – Negative Pregnancy Test/Exam - Positive STI Screening/Counseling STI Test/Exam – Negative STI Test/Exam - Positive Other Sexual/Reproductive Health Behavioral Health Assessment/Intake Brokerage/Referral Case Management Classroom Observation/Support Collateral – Family Collateral – School Staff Collateral – Other Conflict Resolution Crisis Intervention Family Therapy Individual Contact/Meeting Individual Therapy Plan Development Student Success Team/IEP Other Behavioral Health Dental Case Management Diagnostic Services (X-Rays) Preventive (Fluoride/Cleaning) Restorative Services Screening/Assessment/ Examination Sealants Other Dental Group Services Behavioral Health Restorative Justice Health Education Medical External Referrals/Follow-Up (outside SHC) (check all that apply) After Visit (check one) None Needed Behavioral Health Dental Insurance Screening/Enrollment Primary Care Provider/Medical Home Other Medical Provider/Clinic School Support Services Other Sent Back to Class/Recess/Lunch Sent Home (During School Day) Ambulance Other N/A ICD-9 Code Description V20.2 Routine infant or child health check V70.0 Routine general medical examination at a health care facility V70.3 Other general medical examination for administrative purposes V70.5 Health examination of defined subpopulations (for example, students) V70.6 Health examination in population surveys V70.8 Other specified general medical examinations V70.9 Unspecified general medical examination
141_client_services_form_school_health_centers.docx