Utah Department of Administrative Services

Division of Archives & Records Service

Weber-Morgan District Health Department

81093--Tuberculin testing worksheets
17626--Waste tire recycling request records
17627--Pregnancy testing charts
17628--Prenatal care charts
17629--High risk family home unit
17467--Emissions certificate of compliance
25313--Early childhood development home visitation case management records
24555--Health care access case management records
24556--Tobacco education program youth referral form
10159--Sexually transmitted disease clinic charts
10160--High risk infant charts
10161--Infant development case files
10162--Prenatal clinic charts

AGENCY: Weber-Morgan District Health Department

SERIES: 81093
TITLE: Tuberculin testing worksheets
DATES: 1962-
ARRANGEMENT: Numerical by sequential location
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: these worksheets were used to record information from tuberculin test clinics and were submitted to the Utah State Division Health Pulmonary Disease Program. They include name, address, race, sex, age, parental request, test date, date read, previous test, test results, reason why not tested. This is a discontinued school testing program.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years and then destroy.

APPRAISAL

Administrative Historical

this retention is based on discussions with the local health department and the State Health Department. These files are no longer needed administratively and should be immediately destroyed.

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 17626
TITLE: Waste tire recycling request records
DATES: 1993-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These records document financial reimbursements authorized under the State Waste Tire Recycling Act. UCA 26-32a-107 (1995) allows recyclers "using waste tires or materials derived from waste tires" and "used exclusively for energy recovery or creation of ultimate products" to submit applications to local health departments for "partial reimbursement of cost of transporting and processing [waste tires]." These records include correspondence, certification of tire shredding, reimbursement application request, invoices and other supporting documentation.

RETENTION

Retain 5 years

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 5 years and then destroy.

APPRAISAL

Administrative Fiscal

PRIMARY DESIGNATION

Public

SECONDARY DESIGNATION

Protected. customer lists


AGENCY: Weber-Morgan District Health Department

SERIES: 17627
TITLE: Pregnancy testing charts
DATES: 1986-
ARRANGEMENT: Alphabetical by patient's surname

DESCRIPTION: These bilingual forms (English/Spanish) document the results of pregnancy tests given to low-income women by the department. They are used for case management purposes. They include the client's name, birth date, home telephone number, address, occupation, client's legal guardian address and telephone number, questions on housing, transportation, race, marital status, and education; questions on whether patient employed, a U.S. citizen, has insurance, received previous physician's name, whether patient had received previous treatment from the Weber-Morgan Health Department; lifestyle questions; information on the test what information it can and cannot provide; client's signature and date; pregnancy test results, and progress notes; signature and title of worker; and date.

RETENTION

Retain 4 year

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years and then destroy.

APPRAISAL

Administrative Legal

This disposition is based on the legal requirements specified in the malpractice provisions. UCA 78-14-4 (1995) specifies that "no malpractice action . . . may be brought unless it is commenced within two years after the plaintiff or patient discovers, or through the use of reasonable diligence should have discovered the injury, whichever comes first, but not to exceed four years after the date of the alleged act."

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 17628
TITLE: Prenatal care charts
DATES: 1983-
ARRANGEMENT: Alphabetical by patient's name
ANNUAL ACCUMULATION: 1.00 cubic foot.

DESCRIPTION: These case files document prenatal services provided to low income women. They are used for case management purposes. These case files include the patient information and consent form, problem oriented prenatal risk management form, prenatal teaching guideline check list, progress notes, laboratory flow sheet, and the Utah prenatal record system forms (UPRS).

RETENTION

Retain 7 years after last visit

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year after after last visit and then transfer to Agency Record Center. Retain in Agency Record Center for 6 years and then destroy.

APPRAISAL

Administrative Legal

This disposition is based on the legal requirements specified in the Utah Administrative Code, R432-100-35 (1995) and meets the medical malpractice provisions UCA 78-14-4 (1995).

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 17629
TITLE: High risk family home unit
DATES:
ARRANGEMENT:

DESCRIPTION: These records document They include post partem/high risk infant report, individual and family data form, high risk care plan, and progress notes. This program was discontinued in 1990.

RETENTION

Retain 7 years after last visit

DISPOSITION

Destroy.

FORMAT MANAGEMENT

APPRAISAL

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 17467
TITLE: Emissions certificate of compliance
DATES: 1991-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 2.00 cubic feet.

DESCRIPTION: Certificates of emissions testing, used to document compliance to state and federal emissions laws and to permit annual vehicle registration. Includes vehicle type, make, identification number, emissions test results, signature of emissions inspector, and date.

RETENTION

Retain 1 year.

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until administrative need ends and then destroy.

Computer magnetic storage media: Retain in Office for 1 year and then erase.

APPRAISAL

Administrative

This disposition is based on the administrative needs expressed by the department.


AGENCY: Weber-Morgan District Health Department

SERIES: 25313
TITLE: Early childhood development home visitation case management records
DATES: 2001-
ARRANGEMENT: Alphabetical by client's name
ANNUAL ACCUMULATION: 12.00 cubic feet.

DESCRIPTION: These records document services provided by the local health department under the Early child development home visitation program. This program is offered to all infants who receive Medicaid benefits. It is designed to assist the child and its family in receiving provided community benefits. An assessment is made of the child's health, family life, environment, access to services and other non-invasive services. This assessment is used to determine the child's health and to provide the appropriate referrals in the community. The records include a consent for treatment form, initial home visit assessment form, parental referral forms, and the Ogden/Weber referral telephone number list.

RETENTION

Retain 6 years after last entry.

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 6 years after last entry and then destroy.

APPRAISAL

Administrative Legal

This disposition is based on the Medicaid requirements as specified in 42 CFR 491.10 (2003). It states that "the records are retained for at least 6 years from date of the last entry."

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 24555
TITLE: Health care access case management records
DATES: 1990-
ARRANGEMENT: Alphabetical by name

DESCRIPTION: These forms document health interviews of heads of households. They are used to assess family needs and to determine their resources need. The forms include demographic information (name of household name, address, case number, location, medical insurance/medicaid number, primary care physician, language preferred, ethnicity, education level, occupation); current medical information of each family member; a listing of any serious illnesses, injuries, hospitalizations (name, condition, and year); the head of household responses on family's access to health care resources; indication of family's special needs, indication of any at-risk conditions; listing of any planned referrals; and a narrative explaining of action guiding the family to appropriate health care resources.

RETENTION

Retain 4 years.

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years and then destroy.

APPRAISAL

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 24556
TITLE: Tobacco education program youth referral form
DATES: 1990-
ARRANGEMENT: Chronological, thereunder alphabetical by youth's name

DESCRIPTION: This form is used by the Second District Court to refer youths who abused tobacco to the local health department to attend the tobacco education program. It includes referral date, name, age, sex, name of parent/guardian, telephone numbers (work/phone), name of school, referral source (juvenile court, municipal court, school, local police, etc); when a smoking ticket was issued, first time in class, date notified by letter and phone, date of first called, indication by class instructor of class attendance (attendance (y/n), quantity smoked/chewed, project (y/n), assignment (y/n), comments, date progress/completion certificate sent, and tracking record - 1 month, 3 month, 6 months (date, use status, and any comments).

RETENTION

Retain 2 years.

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 2 years and then destroy.

APPRAISAL

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 10159
TITLE: Sexually transmitted disease clinic charts
DATES: 1975-
ARRANGEMENT: Alphabetical by patient's surname
ANNUAL ACCUMULATION: 2.00 cubic feet.

DESCRIPTION: These charts document the treatment provided to persons with sexually transmitted diseases (STD). They are used for collecting and maintaining medical information, in the follow-up of suspected carriers and contacts with sexually transmitted diseases and for controlling the spread of STDs. The Utah Code of Communicable Disease (UCA 26-6-1, et seq._(1991)), the Department of Health is required to maintain this information in order to promote the public health and to prevent and control the spread of STDs. The charts include the consent for treatment form, STD questionnaire, medical visit form, laboratory tests, and requests for specific tests. Information includes case number, patient's name, address, and telephone number; age, race, reason for visit, medications, sex history, problems, allergies, physical examination results, lab tests, impressions, counseling, and follow-up.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 7 years or until after case closed and then destroy.

APPRAISAL

Administrative Legal

This disposition is based on administrative needs expressed by both the State Division of Epidemiology and the local health department and statute of limitations provisions. According to UCA 78-14-4 (1991), an action for malpractice must take place within a maximum of four years from the act.

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 10160
TITLE: High risk infant charts
DATES: 1983-
ARRANGEMENT: Alphabetical by patient's surname
ANNUAL ACCUMULATION: 0.50 cubic feet.

DESCRIPTION: These medical charts document services provided to infants at high risk for medical, social, or developmental problems. This is a locally funded program where physicians and hospitals refer patients to the local health department. Initially, a public health nurse visits the family and undertakes a complete review to determine additional needs. The infant remains in the program for usually a year but no longer than two years. The infant might be referred to the Infant Development Program (IDP). The records include a nursing service household record form, a developmental chart, nursing notes, permission to evaluate form, and motor skills record form. Information includes names of patient and head of household, address, and telephone number; physician's name, address, and telephone number; listing of all members of household including birth date, sex, marital status, relationship to head of household, occupation or education, immunizations received and diagnosis. The charts also include a summary of findings, recommendations, and services provided.

RETENTION

Retain 20 years after case is closed.

DISPOSITION

Destroy provided child has reached the age of 21.

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years after after case closed and then transfer to State Records Center. Retain in State Records Center for 16 years and then destroy provided child has reached the age of 21.

APPRAISAL

Administrative Legal

The disposition is based on potential legal problems that may arise as to any treatment given the infant. While UCA 78-14-4 (1991) sets the limit for malpractice action at four years, court decisions such as Foil v._Ballinger, 601 Pac._Rep._2d 144, Utah Supreme Court (1979) and Myers v._McDonald, 635 Pac._Rep._2d 84, Utah Supreme Court (1981) have held that the statute of limitations can be extended if discovery of the injury did not occur within the four-year time frame. Should any medical problems occur, they should appear by the time the child becomes an adult.

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 10161
TITLE: Infant development case files
DATES: 1988-
ARRANGEMENT: Alphabetical by patient's surname
ANNUAL ACCUMULATION: 2.00 cubic feet.

DESCRIPTION: These case files document the participation of children in the federal Handicapped Children's Early Education Program under 34 CFR 309 and 315 (1991). The Infant Development Program (IDP) deals with children from birth to age three. These case files include permission to evaluate form, feeding behavior assessments, reflex maturation assessment form, Denver developmental screening test, individual family service plan form, IDP roll book form, home visit report forms, infant discharge summary, and infant interim summary reports. The information includes the examination date, the child's name, birth date, the diagnosis, the providers' names and telephone numbers, whether the patient communicated with the providers in the last six months, the date and results of the last physical exam, a record of immunizations, vision screening results, hearing screening results, dental screening results, nutritional status, developmental status, language assessment, and daily activities.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years after case closed and then transfer to State Records Center. Retain in State Records Center for 14 years and then destroy provided child has reached the age of 21.

APPRAISAL

Administrative Legal

This disposition is based on the provisions of the Office of Education's "Special Education Rules" (1988) and discussions with the State Health Department.

PRIMARY DESIGNATION

Private


AGENCY: Weber-Morgan District Health Department

SERIES: 10162
TITLE: Prenatal clinic charts
DATES: 1983-
ARRANGEMENT: Alphabetical by patient's surname
ANNUAL ACCUMULATION: 1.20 cubic feet.

DESCRIPTION: These records document the participation of expectant mothers in the prenatal (PEPI) medical assistance program. While the prenatal clinic's focus is on low-income women, services are not restricted. Charts are closed after the postpartum follow-up. These case files include family practice obstetrical record form, prenatal clinic screening form, chart review form, test results, nurses notes, referral and application for service form, prenatal/postpartum form, obstetrical billing information form, financial statement, hospital reports, and copies of prescriptions.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 7 years after after case closed and then destroy.

APPRAISAL

Administrative Legal

This disposition is based on the administrative needs expressed by the local health department and statute of limitations requirements. According to UCA 78-14-4 (1991), an action for malpractice must take place within a maximum of four years from the act.

PRIMARY DESIGNATION

Private