SCHOOL Tally Sheet
BMI Part 2: Health Conditions Survey
Instructions
Beginning in the 2010-2011 school year, the data submitted to DOH via the HPN system will be collected from the health certificates/appraisals submitted to the school in the previous school year. Additionally, building level data will not be entered on the HPN. Instead building level data will be sent to the School District Nurse coordinator who will then compile and aggregate the data prior to reporting on the HPN.
Data on health conditions and the number of students in the 99th BMI-for-age percentile weight status category must be prepared for submission for each school by totaling the number of students with each condition by grade group (males plus females) and then aggregated and reported at the district level. There are three grade groups:
1) Pre-K, K, 2, and 4
2) 7, 10
3) District Total
To aggregate for the district, use the DISTRICT Tally Sheet BMI Part 2: Health Conditions Survey. We have provided tally sheets and instructions to assist school staff in completing this process. Their use is optional. Please note that data reporting on the Weight Status Category Survey must be consistent with confidentiality requirements imposed by the federal Family Educational Rights and Privacy Act (FERPA).
PURPOSE OF THE TALLY SHEET:
To assist school staff in collecting the health conditions and the 99th and greater BMI-for-age percentile information from individual student health appraisal/certificate forms by grade (males plus females). Tally student health appraisal/certificate data for students in the reportable grades from the PREVIOUS year. For example, use the forms for students currently in Kindergarten (only if in Pre-K last year) and grades 1, 3, 5, 8 and 11 that were submitted the previous school year when those students were in grades K, 2, 4, 7, and 10.
This information should only be obtained from student health certificate/appraisal forms. It cannot be counted if the only documentation for the condition is on the cumulative health record or if medication is administered for the condition.
Health conditions data should be tallied for all students in the reported grades, if available, regardless of weight status category.
INSTRUCTIONS FOR COMPLETION:
Use the “School Tally Sheet BMI Part 2: Health Conditions Survey.”
Complete a new sheet for each grade (males plus females).
Example: □ Pre-K, K, 2, 4 Grade(s) included in tally: _____K, 2______
District: The name of the reporting district.
School: The name of the school.
Group: Check the grade group for this specific report.
Date Completed: The date the tally report is finished and ready to be sent to the School District Nurse coordinator for aggregation at the school district level.
Tallied by: The name of the person completing the tally sheet.
Total Number of Students Enrolled in Grade Group: The number of students in each grade (males plus females). Entering students are required to have a health appraisal or provide a health certificate. For Pre-Kindergarten and Kindergarten students, report only those students who were new entrants last year.
Filling out the Tables:
Suggested method for tallying: For paper records, tally the individual data using a tick or hash mark for each student. For students with more than one health condition, make a mark for each condition. If a health condition is not marked on a student health certificate/appraisal form, leave the tally sheet blank. For example:
Health Conditions / TOTALAsthma / I I I I I I I I / 10
Diabetes, Type 1 / 0
Completing the Sheet:
· After all the students in the specified grade groups have been tallied on the form, count the number of tallies for each health condition and enter the totals in the right-hand column.
· For the 99th and greater BMI-for-age percentile weight status category, you can use the numbers obtained on the SCHOOL Tally Sheet BMI Part 1: Student Weight Status Category Survey by sex to sum the number of males and females and enter it in the box to the right of the TOTAL row.
· PLEASE NOTE—the numbers in the TOTAL columns need to be aggregated at the district level and reported electronically on the HPN. Send the completed SCHOOL tally sheet to the school staff person assigned the HPN role of “School District Nurse” or “Data Reporter” for her/him to tally the data for the district.
08/07/14 Revised, page 2 of 2