Utah Department of Administrative Services

Division of Archives & Records Service

Southwest Utah Public Health Department (Utah)

16846--Immunization personal exemption record
16855--School student immunization assessment annual report
16865--Sudden infant death syndrome (SIDS) files
16932--Infant Development Program (IDP) case files
16955--Quarterly dental health reports
14144--Children'special health services client files
14145--Program operational records
14146--Women, Infants, and Children (WIC) children's participant files
14147--Women, Infants, and Children (WIC) women's participant files
13872--Employees daily activity records
13873--End-of-month work summary
13874--Annual program reports
13875--Quarterly program reports
13876--Monthly program reports
13672--Birth certificates
13673--Birth certificate and birth card applications
13674--Birth and relationship verification
13675--Monthly hospital birth report
13676--Death certificates
13677--Fetal death certificates
13678--Death certificate applications
13679--Death hold book
13680--Monthly cemetery death report
13681--Monthly funeral director's death report
13682--Disinterment permit
13683--Monthly hospital death reports
13684--Monthly nursing home death report
14308--Medicaid notification reports
14310--Blood pressure/cholesterol records
14311--Car seat rental agreement
14313--Drinking water systems survey
14314--Emergency response hazardous waste case files
14315--Environmental complaints
14316--Environmental/Occupational investigations case files
14318--Food establishment application permit
14319--Food handlers permit application records
14320--Food service establishment inspection records
14321--Food service plan review records
14323--Hotels, motels, resorts, and labor camps inspection report
14324--Individual sewage disposal system records
14325--Indoor clean air act complaints
14327--Laboratory test results
14328--Licensed/unlicensed day care facilities, group homes, and jails inspection reports
14329--Rest stop, mobile home parks, and roadway parks inspection reports
14330--Private well records
14331--Recreational camps and temporary mass gathering inspection reports
14332--Scavanger/salvage permits
14333--School building inspection records
14334--Subdivision plats
14335--Swimming pool bacteriological analyses results
14336--Swimming pool inspection report
14337--Swimming pool permits
16492--Communicable disease case file index
16777--Immunization informed consent cards
16560--Communicable disease case files
16562--Communicable disease control program files
16564--Board member application
16565--Board of Health minutes
16566--Capital outlay detail statement
16567--Contracts
16389--Family planning charts
16390--Family planning needs assessment reports
16391--Human immunodeficiency virus case files
16392--Human immunodeficiency virus control program files
16393--Morbidity data summary report
16394--Prenatal health case files
16395--Sexually transmitted disease case files
16396--Sexually transmitted disease program files
16625--Detail collection statement
16397--Tuberculosis client chart files
16647--Employee confidentiality agreements
16649--Expenditures summary statement
16423--Case management files
16668--Women, Infants, and Children (WIC) program financial records
16669--Women, Infants, and Children (WIC) program operational records
16677--Child health evaluation care (CHEC) target area records
16680--Child Health Evaluation Care medicaid reimbursement report
16682--Child health case files
16684--Child health evaluation care screening records
16685--Day care licensing public health nurse review records
16686--Immunization cards

AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16846
TITLE: Immunization personal exemption record
DATES:
ARRANGEMENT:

DESCRIPTION: This is a statewide form provided by the State Health Department to all local health departments. It is used by parents to claim a personal exemption based on a personal belief opposed to immunization in accordance with UCA_53A-11-302.5 (1995). This form must be completed annually to receive continued recognition of the personal exemption. It includes a statement claiming exemption from immunization, parent or guardian's name and signature, address, date, name of child/student exempted, date, school or child care facility's name, witness's signature, title, and date.

RETENTION

Retain until student reached age of 21

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until student reaches age of 21 and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 47.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16855
TITLE: School student immunization assessment annual report
DATES: 1990-
ARRANGEMENT: Chronological, thereunder alphabetical by name of school

DESCRIPTION: These forms document surveys taken by schools or local health departments of children entering kindergarten and child care to determine immunization status. Copies of the forms are sent to the State Department of Health. The forms include name of facility and responsible party, number enrolled in kindergarten or day care, number of children with immunization cards or records turned in to the school, number of children with no record, number of children adequately immunized, number of exemptions (medical, religious, personal), and total number of exemptions. These records are also called Preschool immunization survey sheets.

RETENTION

Retain 2 years

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 77.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16865
TITLE: Sudden infant death syndrome (SIDS) files
DATES:
ARRANGEMENT:

DESCRIPTION: This is part of a federally funded project to research the cause of Sudden Infant Death Syndrome (SIDS). This program is funded under 42 USCA 300c-12 (1991). These records investigate the family background and response to SIDS. The file includes SIDS case information, Nurse Referral Form, and notice from Medical Examiner's Office. Information includes the infant's name and birth date; the date and time found dead; the place of death; the infant's medical history; the maternal and gestation history; record of other SIDS cases in the family; socioeconomic and environmental data; the parents' names, address, dates of birth, religion, educational level, and occupation; the parents' and siblings reactions; the dates of visits; and nurse or counselor's name.

RETENTION

Retain 3 years after case is closed

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years after case closed and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 81.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16932
TITLE: Infant Development Program (IDP) case files
DATES:
ARRANGEMENT:

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). This program deals with children from birth to age three. The files include the permission to evaluate form, referral/intake form, health assessment, developmental tests, feeding behaviors assessment form, reflex maturation assessment, home visit report, individual family service plan, medical records, patient release forms, family identification record, IDP roll book, and information sheets, and access to records form. 8 8

RETENTION

Retain until child reaches the age of 21

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until child reaches the age of 21 and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 51.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16955
TITLE: Quarterly dental health reports
DATES:
ARRANGEMENT: Chronological.

DESCRIPTION: These are reports submitted to the State Bureau of Dental Health on district activities in the field of dental health. They are used in preparation of an annual report to be submitted to the Association of State and Territorial Health Officials. The association then publishes a national annual report. These reports include the district name, the report date, the director's name, the number and type of programs for education and prevention held and the number of persons attending, the number of areas fluoridating water, the names of communities fluoridating water and the number of people served, and the number of dentists assisted in placement. The Bureau of Dental Health maintains the record copy of these reports for two years.

RETENTION

Retain 1 year

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 71.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14144
TITLE: Children'special health services client files
DATES: 1990-
ARRANGEMENT: Numerical by color

DESCRIPTION: These client files document services provided to handicapped children through various clinics such as pediatric assessment, orthopedic, neurological, cardiac, orofacial, etc. The records are transferred from local health departments to the state and back depending on clinic location. After case is closed the client file is transferred to the State Health Department. The client files include a face (summary) sheet, release of information form, application for services form, registration form, an authorization for service form, referral for services form, clinic physician's recommendation form, clinic summary and rescheduling form, progress notes, growth charts, questionnaires for parents or guardians, food record, and a client medical questionnaire.

RETENTION

DISPOSITION

.

FORMAT MANAGEMENT

Paper: Retain in Office until case closed and then transfer to the State Health Department.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 18.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14145
TITLE: Program operational records
DATES: 1979-
ARRANGEMENT: Chronological, thereunder alphabetical by

DESCRIPTION: These records document the operations of local WIC programs. These records include a variety of preliminary reports (monthly, activity, summary reports) and related correspondence.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years after submission of annual or final expenditure report and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 95.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14146
TITLE: Women, Infants, and Children (WIC) children's participant files
DATES: 1979-
ARRANGEMENT: Chronological

DESCRIPTION: These files document the participation of children in the Women, Infants, and Children (WIC) Program. The purpose of the program is to provide supplemental foods and nutrition education to low income families in accordance with the provisions of 7 CFR 246_(1992). This program is open to children between the ages of one and five. These files include the nutritional education record, lost or stolen WIC Voucher/ID Card Report, WIC certification form, nutrition care plan, nutrition education information, WIC participant responsibilities agreement, turnaround change order, family enrollment form, growth charts, infant/child medical history, nutrition history, and correspondence.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until child reaches the age of ten and then destroy and after obtaining written permission from State.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 96.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14147
TITLE: Women, Infants, and Children (WIC) women's participant files
DATES: 1979-
ARRANGEMENT: Chronological

DESCRIPTION: These files document the participation of women in the Women, Infant, and Children (WIC) Program. The purpose of the program is to provide supplemental foods and nutrition education to low income families, in accordance with the provisions of 7 CFR 246_(1992). This program is open to pregnant, postpartum, and breast-feeding women. These files include the nutrition history, notification of eligibility, family enrollment forms, turnabout change order, nutrition education information, nutrition education attendance record, nutrition care plan, pregnancy history, WIC certification form, and the WIC participant responsibilities agreement.

RETENTION

Retain 4 years after end of fiscal year of client's termination after obtaining written permission from State.

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years after end of fiscal year of client's termination and then destroy and after obtaining written permission from State.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 97.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13872
TITLE: Employees daily activity records
DATES: 1987-
ARRANGEMENT: Numerical by employee numbers
ANNUAL ACCUMULATION: 1.00 cubic foot.

DESCRIPTION: These records are completed daily by department employees. The department serves five counties and these records track employees time devoted to specific public health programs and locations. They are used to compile monthly, quarterly, and annual reports. They include employee name and number, date, employee signature, client code and activity, program code, service code, activity code, place, county code, time spent, community health information (client's age, visit type, gender, ethnic code, disposition code), total hours, total contacts (compensatory time earned and used, leave taken, total chargeable hours), and immediate supervisor.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

Administrative

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

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13873
TITLE: End-of-month work summary
DATES: 1987-
ARRANGEMENT: Chronological, thereunder numerical by employee identification number
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: This summary tabulates monthly the daily activities of each employee and is used to verify employee activities and to create reports. It includes employee identification number and name, month and year, and tabulations of daily mileage totals, travel expenses, total public health hours, compensatory time earned and taken, sick leave earned, vacation time earned, chargeable hours, employee's signature, and immediate supervisor's signature.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then transfer to Agency Record Center. Retain in Agency Record Center for 3 years and then destroy.

Paper copy: Retain in Office for 1 year and then destroy.

APPRAISAL

Administrative

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

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13874
TITLE: Annual program reports
DATES: 1987-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: These are annual reports on public health programs administered by the department. They are used to track programs and employee time. They are compiled from the Quarterly program reports (Series 13875). The reports include time spent, number of people seen, names and ages of person served, and sometimes descriptions of program.

RETENTION

DISPOSITION

Transfer to the State Archives with authority to weed.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then transfer to State Archives with authority to weed.

APPRAISAL

Administrative Historical

This disposition is based on both the administrative needs expressed by the department and the historical value of these records to document the activities of the department.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13875
TITLE: Quarterly program reports
DATES: 1987-
ARRANGEMENT: Chronological

DESCRIPTION: These are quarterly reports on various programs administered by the local health department. They are compiled from monthly reports. They are used for management purposes, to provide statistical information about operated programs, and to create an annual report. They include time spent, names, number and ages of people served, and sometimes descriptions of programs.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

Administrative

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 72.

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

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13876
TITLE: Monthly program reports
DATES: 1987-
ARRANGEMENT: Chronological

DESCRIPTION: These are monthly reports on various programs administered by the local health department. They are compiled from Employee daily activity records. They are used for management purposes and to prepare a quarterly report. They include time spent, names, numbers, and ages of patients served, and sometimes the descriptions of program.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until quarterly report is completed and verified and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 65.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13672
TITLE: Birth certificates
DATES: 1969-
ARRANGEMENT: Alphabetical by surname, thereunder alphabetical by birth date
ANNUAL ACCUMULATION: 1.00 cubic foot.

DESCRIPTION: These certificates document all live births in the State of Utah in compliance with UCA 26-2-5 (1992). In 1905, a state registry system of vital statistics was established at the State Health Department with local registrars. All certificates created prior to 1905 are only maintained at the local level and prior to 1978 some local registrars may not have reported all births to the State Health Department. Since 1978, all certificates maintained at the local level are duplicate certificates maintained by the State Health Department. The information recorded includes the child's name, place of birth, date of birth, sex, and if child part of multiple birth; the parents' name, race, age, birthplace, occupation, and marital status; a record of children previously born to the mother; the length of the pregnancy; the child's weight and length at birth; the date of the serological test; and a description of any congenital malformations or birth injuries.

RETENTION

Retain permanently.

DISPOSITION

Retain in agency custody.

FORMAT MANAGEMENT

Paper: Retain in Office permanently.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 3.

PRIMARY DESIGNATION

Exempt. UCA 26-2-22 (2008)


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13673
TITLE: Birth certificate and birth card applications
DATES: 1980-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 2.00 cubic feet.

DESCRIPTION: This application form is used to request a certified birth certificate or birth card. It includes the name, date of birth, and city of birth of the individual whose birth certificate is being requested; the applicant's name, address, telephone number, and relationship to the individual whose birth certificate is being requested; the name, year, and state of birth of the individual's parents; the reason for the request; the request date; and the number of copies of the birth certificate or card requested.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 11.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13674
TITLE: Birth and relationship verification
DATES: 1990-
ARRANGEMENT: Chronological by date processed
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: This request is submitted by the State Division of Family Services to local registrars to search birth records. Since some people cannot afford to obtain birth certificates, it is used to verify births and relationships to receive state benefits. The form includes father's name, an indication which other forms were also completed (acknowledgment of paternity of parents, paternity of father and date, or paternity not acknowledged), mother's name, name of children, birthdate, place, certificate numbers, signature and title of local health official.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 2.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13675
TITLE: Monthly hospital birth report
DATES: 1989-
ARRANGEMENT: Alphabetical by hospital name
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: This three-part form is submitted by hospitals reporting live births that occurred during the month. It is used to ensure that all birth certificates were received as required by UCA 26-2-5 (1992). The original is maintained by the local health department while the first copy is submitted to the State Health Department and the second copy is retained by the reporting hospital. The form includes the month of the report, hospital's name, and a list of births giving the date of birth, the parent's names, the child's sex, and the name of the medical attendant.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 62.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13676
TITLE: Death certificates
DATES: 1977-
ARRANGEMENT: Alphabetical by surname, thereunder chronological by death date
ANNUAL ACCUMULATION: 1.00 cubic foot.

DESCRIPTION: These death certificates document all deaths occurring in the State of Utah as required by UCA 26-2-13 (1992). In 1905, a state registry system of vital statistics was established at the State Health Department with local registrars. All certificates created before 1905 are only maintained at the local health department and prior to 1978 some local registrars may not have reported all deaths. Since 1978, all originals are maintained at the State and copies at the local level. The information recorded includes the deceased's name, gender, date of birth, race, age, county of death, address, birth place, citizenship, marital status, name of spouse, social security number, occupation, and parents' names; cause of death; if an autopsy was taken; if accident, suicide, or homicide caused death; place and time of death; disposition of the body; name and address of mortuary or crematory; and the signature of person certifying death.

RETENTION

Retain permanently.

DISPOSITION

Retain in agency custody.

FORMAT MANAGEMENT

Paper: Retain in State Archives permanently with authority to weed.

APPRAISAL

Historical

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 24.

These records record the death record of individuals.

PRIMARY DESIGNATION

Exempt. UCA 26-2-22 (2008)


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13677
TITLE: Fetal death certificates
DATES: 1977-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: These death certificates document all fetal deaths occurring in the State of Utah as required by UCA 26-2-14 (1993). The certificate is required to be filed with the local registrar within five days after the delivery of a dead fetus. The local registrar transmits the certificate to the State Health Department in accordance with UCA 26-2-19 (1993). The certificate includes local and state file numbers, fetus' name and sex, delivery date and time, delivery place, delivery location (city, county), residence (state, county, city, location, address, zip code), race, parent information, pregnancy history, cause of death, attendant's name and signature, disposition of fetus, date, registrar's signature, and medical and health information. The State Health Department retains the official copy permanently while local health departments retain their copies to respond to local requests.

RETENTION

Retain permanently.

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper copy: Retain in Office permanently or until state vital records system is computerized and then destroy.

APPRAISAL

Administrative

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

PRIMARY DESIGNATION

Exempt. UCA 26-2-22 (2008)


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13678
TITLE: Death certificate applications
DATES: 1989-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 2.00 cubic feet.

DESCRIPTION: This application is used to request a certified death certificate. It includes identifying information, death date, deceased's name, place of death, county birthplace of decedent, usual residence of decedent, name of father, mother, reason for requesting including relationship to person whose certificate is requested, signature of applicant, address, phone, date, number requested, and fee amount.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 12.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13679
TITLE: Death hold book
DATES: 1983-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: This book serves as a tracking device recording the status of death certificates. Death certificates are required to be filed prior to the funeral, but if this is not possible the mortuary will notify the local registrar and receive a hold number. This book is used to verify that death certificates were finally received. It includes hold number, death date, decedent's name, physician, funeral director, decedent's age, burial date, city of death, date hold number issued, date received, number of copies issued, whether the death certificate is pending and whether or not a burial transit was issued.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 25.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13680
TITLE: Monthly cemetery death report
DATES: 1989-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: This three-part report form lists all interments and is prepared monthly by all cemeteries in the state and submitted to their local health department as required by UCA 26-2-18 (1992). The information is used by the department to verify that all death certificates are being received. The original is retained by the local health department, the first copy is submitted to the State Health Department and the second copy is retained by the cemetery. The form includes the month and year, the name and location of the cemetery, death date, deceased's name and age, the county where death occurred, and the name of the funeral home or funeral director.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 60.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13681
TITLE: Monthly funeral director's death report
DATES: 1989-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 0.20 cubic feet.

DESCRIPTION: This three-part monthly report is submitted by funeral directors for each casket furnished and for funerals performed where no casket was furnished as required by UCA 26-2-16 (1992). It is used to ensure that all death certificates are filed. The original is maintained by the local health department while the first copy is submitted to the State Health Department and the second copy is retained by the submitting funeral director. The information includes the month of the report, the name and location of the funeral home, and a list of deaths for the period giving for each the date of death, the name of the deceased, the age of the deceased, the name of the medical attendant, and the county where death occurred.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 61.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13682
TITLE: Disinterment permit
DATES: 1984-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: This permit allows for the disinterment of burial remains from a cemetery. The form includes county, city, date permit issued, applicant's name, deceased's name, age, sex, place of death, death date, cemetery or city from and to, next of kin signature, permit number, and signature of local registrar at disinterment.

RETENTION

Retain permanently.

DISPOSITION

Retain in agency custody.

FORMAT MANAGEMENT

Paper: Retain in Office permanently.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 27.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13683
TITLE: Monthly hospital death reports
DATES: 1980-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: This three-part form is submitted monthly by all hospitals reporting all deaths, fetal deaths, or abortions that occurred during the month. It is required by UCA 26-2-23(3) (1991) and is used to ensure that all death certificates are filed. The original is maintained by the local health department with the first copy being submitted to the State Health Department and the second copy is retained by the submitting hospital. The form includes the month being reported, hospital's name and location, a list of deaths giving the date of death, the name and age of the deceased, the name of the medical attendant, and the name of the funeral home or funeral director.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 63.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13684
TITLE: Monthly nursing home death report
DATES: 1980-
ARRANGEMENT: Chronological
ANNUAL ACCUMULATION: 0.10 cubic feet.

DESCRIPTION: This three-part report form is submitted by nursing homes reporting deaths that occurred during the previous month. This report is required by UCA 26-2-23 (1992). It is used to determine whether certificates have been received for all deaths and to create state reports. The original record is kept by the local health department while the first copy is submitted to the State Health Department and the second copy is kept by the nursing home. The information includes the month of the report, the nursing home's name, death date, deceased's name, the age at death, medical attendant's name, and the name of the funeral home or funeral director.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 64.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14308
TITLE: Medicaid notification reports
DATES: 1967-
ARRANGEMENT: Alphabetical by surname

DESCRIPTION: This report lists all individuals or families in the county on medicaid including high risk individuals. It is used to ensure that all individuals eligible to enroll in Medicaid programs are notified and to determine individual eligibility. The report includes case number, recipient name, address, telephone number, and identification number, birth date, whether they have seen a doctor or dentist, date of eligibility, and mother's name.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

Microfiche master: Retain in State Records Center for 3 years and then destroy.

Microfiche duplicate: Retain in State Records Center for 3 years and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 58.

This disposition is based on

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14310
TITLE: Blood pressure/cholesterol records
DATES: 1980-
ARRANGEMENT: Alphabetical by surname

DESCRIPTION: These records are a two-part form completed by health workers for clients having blood pressure and cholesterol health screenings. These informal screenings are held at various locations throughout the district including shopping centers and health fairs. They are used to identify existing health problems and to encourage healthy lifestyles. The original (white copy) is submitted to the State Bureau of Chronic Disease Control and is maintained as the record copy while the yellow copy is retained by the local health department. The form includes the name, address, social security number, phone number, weight, height, birth date, age, gender, ethnic origin, education level, questions concerning smoking, questions concerning blood pressure and blood cholesterol, brief family and individual medical history, blood pressure readings, blood cholesterol readings and signed consent authorizing blood pressure and cholesterol tests.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 4.

This disposition is based on

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14311
TITLE: Car seat rental agreement
DATES: 1980-
ARRANGEMENT: Alphabetical by surname

DESCRIPTION: These contracts document the rentals of car seats to individuals who choose not to buy their own. This program enables those individuals to comply with UCA 41-6-148.20 (1992) which requires the use of child restraint devices. These contracts include the car seat number; the return date; the name, address, telephone number, drivers license number, and borrower's signature; the names and addresses of two individuals who will know the whereabouts of the borrower; a parental checklist that the borrower received training in the use of the car seat and that the seat was inspected; the amount paid; the dates issued and due; the seat condition when issued; and the receipt number. Some local health department also sell car seats.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years after expiration of the contract and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 9.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14313
TITLE: Drinking water systems survey
DATES: 1993-
ARRANGEMENT: Alphabetical by company name.

DESCRIPTION: These surveys record the inspections of water tanks for proper security, sanitation, proper maintenance, sanitation, and chlorine levels to guarantee water quality. The survey forms include date, name and address of owner, location of water system, results of inspection, and signature of sanitarian.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until system no longer in operation and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 28.

This disposition is based on

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14314
TITLE: Emergency response hazardous waste case files
DATES: 1972-
ARRANGEMENT: Alphabetical by company or individual name

DESCRIPTION: These case files document the investigation of hazardous waste incidents including the cleanup, the process and the proper waste disposal. The case files include complaint date, time, and number; complainant's name, address, and telephone number; spill location; material spilled; weather conditions/local terrain; time on scene; population area; personnel on scene; volume of spill; anticipated movement of spill; action taken; water bodies or streams involved; name of shipper/manufacturer; chemical placarding/laveling information; container type; railroad/truck ID number; injury or exposure; samples taken; and signature of registered environmental health specialist.

RETENTION

Retain permanently.

DISPOSITION

Retain in agency custody.

FORMAT MANAGEMENT

Paper: Retain in Office permanently.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 29.

PRIMARY DESIGNATION

Public

SECONDARY DESIGNATION

Protected. trade secrets, confidential informant information


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14315
TITLE: Environmental complaints
DATES: 1972-
ARRANGEMENT: Alphabetical by surname

DESCRIPTION: These forms record complaints received by the local health department from the public in reference to a wide-range of environmental concerns including air quality, solid waste, hazardous waste, epidemiology, indoor clean air, infectious waste, swimming pools, schools, vector control, food service, landlords, animals, housing, and yards. If complaint pertains to a specific facility it becomes part of the facility's inspection file. The form includes date, time, name of persons taking complaint, complainant's name, address, and telephone number; nature of complaint, date investigated, action taken, completion date, and signature of registered environmental health specialist.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 31.

This disposition is based on

PRIMARY DESIGNATION

Public

SECONDARY DESIGNATION

Private. complainant's name, home address, and telephone number


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14316
TITLE: Environmental/Occupational investigations case files
DATES: 1972-
ARRANGEMENT: Alphabetical by surname

DESCRIPTION: These are records of epidemiological investigations of environmental and occupational public health hazards. They help prevent those hazards, and assist in short and long-term health studies. As stated in the Utah Code of Communicable Disease Rules, the Department of Health collects this information in order to promote and protect the public health and to prevent and control disease. Includes epidemiological investigations of individuals and/or groups exposed to environmental health hazards, health risk analyses of human exposures to chemical contaminants, cancer cluster investigations, and adverse reproductive outcomes. Medical records may contain patient name, address, sex, race, age, type of exposure, company where possible exposure occurred. The State Bureau of Epidemiology maintains the record copy of these records permanently.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 7 years after after completion of investigation and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 32.

This disposition is based on

PRIMARY DESIGNATION

Public

SECONDARY DESIGNATION

Private. Patient/case files


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14318
TITLE: Food establishment application permit
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: This is an application used to obtain a permit to operate a food establishment. The form includes date, business name, address, and telephone number; applicant's name, address, and telephone number; business type; a statement signed by applicant indicating permit conditions; fee amount; permit number; name of person approving application, and the name and address of property owner.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 37.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14319
TITLE: Food handlers permit application records
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These forms document the application and issuance of food handlers permits. They include applicant's name, address, and telephone number, date, birth date, sex, physical description, place and address of employment site, whether permit previously issued, and applicant signature.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 38.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14320
TITLE: Food service establishment inspection records
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These are reports on inspections of food service establishments to ensure that proper methods of food preparation and sanitation are followed. These inspections are authorized under UCA_ 26-15-15-2(1), 26A-1-113, 26A-1-114(1)(g) (1992). These reports include the name and address of the owner; the name of the establishment; the inspection purpose (follow-up, regular, etc); the date by which identified violations must be corrected; the inspector's comments; and the results of the inspection of food, food protection, personnel, food equipment and utensils, water, wastewater, plumbing, toilet and hand washing facilities, solid waste disposal, insect/rodent/animal control, floors, walls, and ceilings, lighting, ventilation, dressing rooms, other operations, living quarters/laundry; the rating score; and inspector's name.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 39.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14321
TITLE: Food service plan review records
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These review forms document the local health department's review of food service plans prior to the opening of the establishment. This is part of the local health departments duties as set out in UCA 26A-1-114 (2)(a)(1992). The department reviews floor plans, equipment schedules, plumbing plan and schedule, lighting plan, finish schedule (floors, walls, and ceiling), and equipment details when necessary to determine whether food establishments meet general requirements for bathrooms, washing facilities, plumbing, cooking equipment, grease traps, lighting, waste disposal, and other facilities prior to the opening of the establishment. These forms include the establishment's name, address, mailing address, and telephone number, reviewers name, date, a listing of any areas of concern, and comments.

RETENTION

Retain 3 years

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 40.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14323
TITLE: Hotels, motels, resorts, and labor camps inspection report
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: This state report form documents health inspections of all hotels, motels, resorts, and labor camps. Any deficiencies discovered in the inspection must be corrected before next routine inspection or a specified period or facility could be closed until work is completed. The report form includes establishment's name, establishment type, city, county, lodging unit numbers, secondary water source, on-site sewage disposal type, owner's name and address, health district, lessee's name and address, inspection type (routine, complaint, construction inspection, request, follow-up inspection, pre-opening inspection, survey, and other), and results of inspection concerning water supply, wastewater disposal, service buildings or restroom facilities, housing, laundry facilities, swimming or wading facilities, solid waste, and specific remarks, date, owner's or representative's signature, and sanitarian's

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 42.

This disposition is based on

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14324
TITLE: Individual sewage disposal system records
DATES: 1972-
ARRANGEMENT: Alphabetical by surname

DESCRIPTION: These files document the approval by the department for the construction of individual sewage treatment equipment, as authorized by UCA 26A-1-115(2)(1992). This form includes the property address, owner or mortgagor name, contractor's name, final inspection date, the number of bedrooms, subdivision where property is located, the lot number, whether the property has a basement, the seepage rate, water supply type and source, water source description, a description of the septic tank (capacity, dimensions, access, etc.), seepage pit description, distribution box description, disposal field description, whether the construction is approved or not, and inspector's name.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until systeme is updated or longer in use and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 48.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14325
TITLE: Indoor clean air act complaints
DATES: 1982-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These forms record complaints received for individual's smoking in public buildings. They include date and time; name, sex, address, birthdate, location of complaintant; violator's name and signature; and violator's name.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 50.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14327
TITLE: Laboratory test results
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: This record is used to assist in the collection of lab test results and to complete patient medical records and verifications of diagnoses. As stated in the Utah Code of Communicable Disease Rules, the Department of Health collects this information in order to protect the public health and protect and control disease. Includes reports such as Request for Serologic Test for Syphilis, Request for Culture of Enteric Bacterial Pathogens, Request for Referred Culture Identification, Report of Antibiotic Sensitivity, Request for Agglutinations and Special Serologic Tests, Request for Miscellaneous Cultures, Request for Rabies Examination, Request for Slide Examination, and Request for Mycobacteria Examination. The State Bureau of Epidemiology retains the record for five years and then destroys.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 56.

PRIMARY DESIGNATION

Exempt. UCA 26-25a-101 (2008)


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14328
TITLE: Licensed/unlicensed day care facilities, group homes, and jails inspection reports
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These report forms document inspections of licensed/unlicensed day care facilities, group homes, and jails. These inspections are part of the local health departments duties as specified in UCA_26A-1-114_(1)(g) (1992). These forms include facility's name and address, operator's name, facility type, indications whether inspection identified any deficiencies in facility's structure, bathrooms, safety, plumbing, outside facilities, food service, vermin control, housekeeping and general cleanliness, managers signature and telephone number, environmental health specialist's signature and date, and an indication whether inspection approved,conditionally approved, or denied the continued operation of facility. Any identified deficiencies are required to be completed within thirty days or facility could be closed for noncompliance.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 6 years or until litigation settled and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 57.

This disposition is based on

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14329
TITLE: Rest stop, mobile home parks, and roadway parks inspection reports
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These report forms document the health department inspections of mobile home parks, recreational vehicle parks, and roadway rest stops. All deficiencies discovered must be corrected by the next routine inspection or a specified time period or facilities could be closed for noncompliance (UCA 26A-1-114 (1992)). The report form includes name of park or rest stop, city, county, health department, number of spaces occupied (independent, dependent, self-contained), secondary water source, on-site sewage disposal site, owner's/operator's name and address, type of inspection (routine, complaint, construction inspection, request, follow-up, pre-opening, survey, other), inspection results concerning water supply, wastewater disposal, service buildings, swimming and wading facilities, and solid waste disposal, any specific remarks, date, owner's or representative's signature, and sanitarian's signature.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy provided any pending claim or litigation has been resolved.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 59.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14330
TITLE: Private well records
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These records document the approval of the department for the construction and use of private wells, as authorized by UCA 26A-1-115(1) (1992). The State Health Department maintains the listing of all private wells and retains record copy of state approvals. These records include the property address, owner name, contractor's name, final inspection date, subdivision where property is located, water supply type, source, and description, whether construction approved or not, results of water quality tests, and inspector's name.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until well is no longer in use and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 69.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14331
TITLE: Recreational camps and temporary mass gathering inspection reports
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These records document the approval of the department for the construction and use of private wells, as authorized by UCA 26A-1-115(1) (1992). The State Health Department maintains the listing of all private wells and retains record copy of state approvals. These records include the property address, owner name, contractor's name, final inspection date, subdivision where property is located, water supply type, source, and description, whether construction approved or not, results of water quality tests, and inspector's name. report of inspection on site, water supply, waste water disposal, service buildings, housing, swimming or wading facilities, solid waste, and first aid facilities; any applicable remarks; date; operator's or representative's signature, and signature of sanitarian. All deficiencies must be corrected before next inspection or specified period or facility could be closed for noncompliance (UCA 26A-1-114(1)(g) (1992)).

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 73.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14332
TITLE: Scavanger/salvage permits
DATES: 1977-
ARRANGEMENT: Alphabetical of company name

DESCRIPTION: These files document the issuance of permits under the authority of UCA 26A-1-114(1)(a) (1992) allowing the holder to engage in the business of emptying, or cleaning any vault, privy, septic tank, cesspool, or grease trap, automobile salvage, by-product disposal, and recycling. These permits include permit holder's name, the business name, the permit holder's home and business addresses, the date issued, expiration date, the property owner's name, business type, application's approval date and the permit number.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 2 years after permit expires or has been terminated and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 75.

This disposition is based on

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14333
TITLE: School building inspection records
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These files document the inspections conducted by the local health agency to ensure that the school buildings and premises are safe for use by the students and school personnel. This is part of the local health agencies duties as set out in UCA 26A-1-114(3) (1992). These inspection forms include school district's name, school type, school's name, enrollment, number of class and work rooms, inspection date, inspector's name, the inspector's remarks, and the results of the inspection of the grounds, school rooms, floors, walls, ceilings, chalkboards, heating, ventilation, lighting, seating, water supply, hand washing facilities, toilet facilities, locker facilities, shower rooms, and waste disposal.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 76.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14334
TITLE: Subdivision plats
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These are copies of plats prepared by real estate developers showing the layout of lots in a subdivision. The department reviews these plats to ensure that proper sanitary facilities for the lots are included in the plan. The plats include surveyor's name, boundary description, subdivision name, date of acceptance by the legislative body, the date and terms of approval by the local health department, and the date of approval by the planning commission.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year or until administrative need ends and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 80.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14335
TITLE: Swimming pool bacteriological analyses results
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These are test results for the inspection of public swimming pools to ensure that they comply with the requirements of UCA_ 26-15-2(2)_(1992). These results include the county name, water supply source, the date the sample was collected, the lab number where tested, the individual name collecting the sample, and the test results.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 82.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14336
TITLE: Swimming pool inspection report
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: This is a report on the inspection of public swimming pools as required by UCA 26A-1-114(1) and 26-15-2 (1992). This report form includes the pool name, pool address, owner's name, operator's name, the date and time of the inspection, the number of bathers during the inspection, inspector's name, and inspection results.

RETENTION

Retain 4 years.

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 83.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 14337
TITLE: Swimming pool permits
DATES: 1972-
ARRANGEMENT: Alphabetical by company name

DESCRIPTION: These files document the issuance of permits by the health department to operate public swimming pools. The permits include the permit holder's name, the business name, the permit holder's home and business addresses, the date issued, expiration date, property owner's name, the type of business, date application approved, and permit number.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 2 years after the permit expires or has been terminated and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 84.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16492
TITLE: Communicable disease case file index
DATES: 1990-
ARRANGEMENT: Alphabetical by patient's surname

DESCRIPTION: This is an index of easily accessible basic patient and statistical information regarding reportable communicable diseases. As stated in the Utah Code of Communicable Disease Rules, the information enables the Department to protect the public health, and prevent and control disease. Includes patient's case number, name, address, race, sex, and age; the report source and the date reported; onset date of the disease; the attending physician; the patient's hospital; lab results; disease specification of type, if applicable; and the date the form was sent to Center for Disease Control, if applicable. Some of the diseases include amebiasis, ascariasis, botulism, campylobacter, cocciodomycosis, and Colorado tick fever. The State Bureau of Epidemiology maintains the record copy of these records permanently.

RETENTION

Retain 7 years after closed

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 19.

PRIMARY DESIGNATION

Exempt. UCA 26-25a-101 (2008)


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16777
TITLE: Immunization informed consent cards
DATES: 1990-
ARRANGEMENT: Alphabetical by patient's name

DESCRIPTION: These are forms filled out by parents before their children receive immunization for measles, mumps, rubella, polio, diphtheria, tetanus, and pertussis. Consent is secured to help protect the local department against suit for failure to obtain informed consent under UCA 78-14-5 (1992). These forms include the patient's name, address, age, and date of birth; the signature of the consenting adult; and a printed description of the benefits and risks of the vaccine.

RETENTION

Retain 7 years after last visit.

DISPOSITION

Destroy provided client has reached the age of 21.

FORMAT MANAGEMENT

Paper: Retain in Office for 7 years after last visit and then destroy provided client has reached the age of 21.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 46.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16560
TITLE: Communicable disease case files
DATES:
ARRANGEMENT:

DESCRIPTION: These files are kept in order to maintain a concise, accurate, and historical record of reportable communicable diseases and epidemiological investigations. As stated in the Utah Code of Communicable Disease Rules, the reports enable the Department of Health to protect the public health, and prevent and control communicable disease. Includes investigations such as Botulism Alert Summary, Reyes Syndrome Case Investigation Report, Leprosy Surveillance, Outbreak Investigation, Infant Botulism, Pertussis Report, and Weekly Campylobachter Surveillance Report; also includes original incoming and copies of outgoing correspondence related to epidemiological investigations. The State Bureau of Epidemiology maintains the record copy of the records permanently.

RETENTION

Retain 7 years after case closed

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 20.

PRIMARY DESIGNATION

Exempt. UCA 26-25a-101 (2008)


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16562
TITLE: Communicable disease control program files
DATES:
ARRANGEMENT:

DESCRIPTION: This is a record of incoming and outgoing correspondence, related to the Communicable Disease Control Program. Includes financial, medical, disease control, and patient information; policies, procedures, rules, regulations, ordinances; and general program operational files. The State Bureau of Epidemiology maintains the record copy of these records.

RETENTION

Retain until updated or superseded

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until superseded and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 21.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16564
TITLE: Board member application
DATES:
ARRANGEMENT:

DESCRIPTION: This is an application used to apply for a position on the local board of health. All applications are retained for two years to create a pool for possible future openings. The form includes name, address, business and home telephone numbers, education and work experience in health and environmental fields, volunteer experience, reasons for wanting to serve on board, occupation, signature and date.

RETENTION

Retain 2 years after appointment is made

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 5.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16565
TITLE: Board of Health minutes
DATES:
ARRANGEMENT:

DESCRIPTION: These minutes document the actions of the local boards of health. Each local health department is required to have a board of health "appointed by the local governing body and shall consist of at least five persons" (UCA 26A-1-109 (1992)). The Board of Health is responsible for establishing policy, for adopting regulations relating to health protection and the promotion of public health or environmental health including but not limited to public health administration and support services, maternal and child health, communicable disease control, surveillance and epidemiology, food protection, solid waste management, wastewater management and safe drinking water management. They include the agenda and the actual minutes of proceedings of special and regular meetings of the local Boards of Health.

RETENTION

Retain permanently.

DISPOSITION

Retain in agency custody.

FORMAT MANAGEMENT

Paper: Retain in Office permanently.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 6.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16566
TITLE: Capital outlay detail statement
DATES: 1990-
ARRANGEMENT: Chronological

DESCRIPTION: This is a monthly report submitted by the local health department to the state Department of Health listing the amounts spent for capital outlay on state contracts. It includes the local health department's name, the reporting period, payee's name, the contract or program where the outlay was made, and expenditure amount.

RETENTION

Retain 3 years

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years or until state audit and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 8.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16567
TITLE: Contracts
DATES: 1980-
ARRANGEMENT:

DESCRIPTION: These are contracts between local health departments and the State Health Department. They document agreements between the state and local departments to operate specific programs. The State Health Department regrants federal funds and grants state funds under certain requirements stated in the contracts.

RETENTION

Retain 6 yearss after expiration of contract

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 6 years after expiration of contract and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 22.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16389
TITLE: Family planning charts
DATES:
ARRANGEMENT:

DESCRIPTION: These charts document services provided to individuals enrolled in the family planning program funded by federal grants under Section 1001 of the Public Health Service Act. The purpose of the grant is to provide educational, comprehensive medical, and social services necessary to aid families, particularly low income families, to determine freely the number and spacing of their children. These files include a physical examination form, a record of client visits, progress notes, face sheet, financial form, signed consent forms, contraceptive method authorization forms, and laboratory test results.

RETENTION

Retain 7 years after client leaves the program

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 7 years after client leaves program and then destroy provided client has reached the age of 21.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 34.

PRIMARY DESIGNATION

Exempt. 42 CFR 59.15 (1991)


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16390
TITLE: Family planning needs assessment reports
DATES:
ARRANGEMENT:

DESCRIPTION: This is a report submitted to the State Bureau of Family Planning showing the needs for family planning funds and the performance plan for the upcoming year. It is used in distributing grant money. It includes the local district name, the number of births to teens out of wedlock, abortion numbers, the infant mortality rate, the number of births in families below 150 percent of poverty, and the increase or decrease of each category from the previous year. The record copy of this report is retained by the State Bureau of Family Planning permanently.

RETENTION

Retain 1 year and then destroy

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 35.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16391
TITLE: Human immunodeficiency virus case files
DATES:
ARRANGEMENT:

DESCRIPTION: These files contain medical and epidemiological information on patients, suspects and contacts for future research and disease intervention strategies. As stated in the Utah Code of Communicable Disease Rules, the reports are intended to enable the Department of Health to protect the public health, and prevent and control communicable disease. Information includes patient's name, telephone number and address; physician's name and telephone number; the hospital; medical record number; name and phone number of the person completing form; date form completed; status report (new case or update); and the reporting health department. The State Bureau of HIV/AIDS Prevention and Control maintains the record copy of these case files permanently.

RETENTION

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years after case closed and then destroy provided records for minors are retained until reach 21.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 43.

PRIMARY DESIGNATION

Exempt. UCA 26-6-20.5 (2008), UCA 26-25a-101 (2008)


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16392
TITLE: Human immunodeficiency virus control program files
DATES:
ARRANGEMENT:

DESCRIPTION: This is a record of incoming and outgoing correspondence related to the operations of the AIDS Control Program. Includes medical, disease control and patient information regarding AIDS and HIV; narratives; summary data reports; grants information, finance, policies, procedures, rules, regulations, ordinances; and other general program operational files. The State Bureau of HIV/AIDS Prevention and Control maintain the record copy of these records which are transferred to the State Archives after they have been superseded.

RETENTION

Retain until updated or superseded

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until updated or superseded and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 44.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16393
TITLE: Morbidity data summary report
DATES:
ARRANGEMENT:

DESCRIPTION: These are morbidity statistics for all reportable diseases and diseases of public health importance. As stated in the Utah Code of Communicable Disease Rules, the Department of Health collects this information in order to promote the public health and to prevent and control disease. They are used for federal, state, and local agencies, the general public, and for the functioning and management of the Bureau. Statistics provide information by year, county, month, and show distribution by age and sex. The State Bureau of Epidemiology retains the record copy of these records permanently.

RETENTION

Retain until administrative need ends and then destroy

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 66.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16394
TITLE: Prenatal health case files
DATES:
ARRANGEMENT:

DESCRIPTION: These are case files for women who are eligible for the prenatal (PEPI) program. This program is for low income pregnant women who were presumed eligible for medicaid or who are on medicaid. The local health department performs an initial interview to determine the woman's eligibility. Once the woman is determined eligible she is assigned to a registered nurse who then contacts the client every month and performs home visits. Each of these components are documented in each client's chart. The client is maintained in the program for two months after the pregnancy ends. The case file includes prenatal care coordination tracking record form, nursing notes, prenatal initiative form, Utah Perinatal record system (UPRS), identification card, health insurance claim form, and release of information form. These case files may also be called "Baby Your Baby case files."

RETENTION

Retain 7 years after last visit and then destroy

DISPOSITION

Destroy.

FORMAT MANAGEMENT

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

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 68.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16395
TITLE: Sexually transmitted disease case files
DATES:
ARRANGEMENT:

DESCRIPTION: These files are used in maintaining and locating medical information, and in the follow up of suspects, cases and contacts with Sexually transmitted diseases (STD) and for controlling the spread of STDs. As stated in the Utah Code of Communicable Disease Rules, 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 disease. The files include laboratory test cards, interstate transmission control identification forms, gonorrhea epidemiologic control records, infectious syphilis epidemiologic control records, original interview information, reinterview record and cluster interview records.

RETENTION

Retain 4 years after case is closed and then destroy

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 4 years after case is closed and then destroy provided records for minors are retained reach 21 years.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 78.

PRIMARY DESIGNATION

Exempt. UCA 26-25a-101 (2008)


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16396
TITLE: Sexually transmitted disease program files
DATES: 1970-
ARRANGEMENT: Alphabetical by subject

DESCRIPTION: This is a record of incoming and outgoing correspondence related to the Sexually Transmitted Disease (STD) Control Program. Includes financial, medical, disease control and patient information regarding sexually transmitted diseases; policies, procedures, rules, regulations, and ordinances; summary data of STDs by month, quarter and year; and other general program operational files. The State Bureau of Epidemiology maintains the record copy of these records.

RETENTION

Retain updated or superseded and then destroy

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until updated or superseded and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 79.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16625
TITLE: Detail collection statement
DATES: 1990-
ARRANGEMENT: Chronological

DESCRIPTION: This is a monthly statement sent to the Department of Health reporting the amount of fees collected by the local health departments from patients or clients on state contracts. This statement includes the local health department name, month, the allocation of collections by contract or program type, the type of collection (vital statistics, patient fees, etc.), the amount of the collections, and the total amount collected.

RETENTION

Retain 3 years or until sltate health department audit

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years or until state health department audit and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 26.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16397
TITLE: Tuberculosis client chart files
DATES:
ARRANGEMENT:

DESCRIPTION: These case files document services provided to clients being treated for active diseases or for a positive tuberculin test reaction. The original files are retained at local health department, with certain information being sent to the State Health Department. The files include a questionnaire, test results, chest x-rays report as needed, information consent forms, medication sheet, and nursing notes.

RETENTION

Retain 7 years after case closed

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 7 years after case closed and then destroy provided patient has reached age of 21.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 87.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16647
TITLE: Employee confidentiality agreements
DATES: 1990-
ARRANGEMENT: Alphabetical by surname

DESCRIPTION: This agreement is signed by the employee and maintained by the department stating that the employee will not disclose confidential information in accordance with UCA 26-25-4 (1992). The agreement usually becomes part of the employee's official personnel file. It includes the terms of the agreement, the date, employee's signature, and supervisor's signature.

RETENTION

Retain until final disposition of personnel file

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until final disposition of personnel file and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 30.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16649
TITLE: Expenditures summary statement
DATES:
ARRANGEMENT:

DESCRIPTION: This is a monthly statement sent to the state Department of Health to bill for expenses incurred on state contracts. This statement includes the name of the local health department,

RETENTION

Retain 3 years or after state health department audit

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years or until state health department audit and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 33.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16423
TITLE: Case management files
DATES: 1993-
ARRANGEMENT: numerical

DESCRIPTION: These files, required by 42 CFR 441.56(a) (1990), are used by the health department to ensure that all individuals who are eligible to enroll in the medicaid program are notified; and to determine eligibility of individuals accepted into the program. These files include the case management form, recipient list, and screening notifications.

RETENTION

Retain 3 years and then destroy

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 10.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16668
TITLE: Women, Infants, and Children (WIC) program financial records
DATES:
ARRANGEMENT:

DESCRIPTION: These records document the expenditure of monies for projects funded under the WIC program. These records include receipts, check registers, and a variety of financial reports.

RETENTION

Retain 3 years after submission of annual or final expenditure report

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years after submission of annual or final expenditure report and then destroy provided any pending litigation has been resolved.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 94.

PRIMARY DESIGNATION

Public

SECONDARY DESIGNATION

Private. names, address, telephone numbers, and expenditures to individual client's


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16669
TITLE: Women, Infants, and Children (WIC) program operational records
DATES:
ARRANGEMENT:

DESCRIPTION: These records document the operations of local WIC programs. These records include a variety of preliminary reports (monthly, activity, summary reports) and related correspondence.

RETENTION

Retain 3 years after submission of annual or final expenditure report

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years after submission of annual or final expenditure report and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 95.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16677
TITLE: Child health evaluation care (CHEC) target area records
DATES:
ARRANGEMENT:

DESCRIPTION: These records are consent and release forms distributed by the Children Health Evaluation Care (CHEC) program. Each local health department determines concentration areas and groups to be targeted. This form is used to notify parents within targeted groups of the services provided and to identify infants eligible for the program. These records include both originals and duplicates. The form includes an explanation of the CHEC program, a statement on confidentiality of personal information collected, a statement allowing for the release of information for follow-up purposes containing the date, parent's name, address, telephone number, signature, birth date, social security number, marital status, and number of children.

RETENTION

Retain 3 years

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 14.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16680
TITLE: Child Health Evaluation Care medicaid reimbursement report
DATES:
ARRANGEMENT:

DESCRIPTION: This form reports the reimbursements received on claims for physical examinations provided under the Child Health Evaluation (CHEC) program. A medicaid billing form is submitted for each completed examination and the original is submitted to the Utah Medical Assistance Program (UMAP) for reimbursement. This form includes child's name, date service provided, date into program, home address, phone number, medical information and patient identification number.

RETENTION

Retain 3 years

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 15.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16682
TITLE: Child health case files
DATES:
ARRANGEMENT:

DESCRIPTION: These case files document the participation of children in the Child Health Evaluation and Care Program (CHEC). This is a low cost program to identify public health problems and to promote healthy children in low income families ineligible for Medicaid. These files are also used to document participation in the program and to record the children's development. They include the child health record, well child care 4-5 years of age form, and well child care examination forms. These records are also called Well Child case files.

RETENTION

Retain until child reaches the age of 21

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until child reaches age of 21 and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 16.

PRIMARY DESIGNATION

Private


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16684
TITLE: Child health evaluation care screening records
DATES: 1970-
ARRANGEMENT: Alphabetical by name.

DESCRIPTION: These files document services provided to children accepted in the Child Health Evaluation Care (CHEC) program as part of the medicaid program. The purpose of the screening is to examine and evaluate the general physical and mental health, growth, development, and nutritional status of medicaid recipients under the age of 21 and to provide corrective treatment. These files include the screening evaluation, claim forms, child health conference evaluation forms, progress form, history form, immunizations, assessment forms, medicaid records, and growth charts.

RETENTION

Retain until child reaches the age of 21.

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until child reaches the age of 21 and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 17.

PRIMARY DESIGNATION

Private

SECONDARY DESIGNATION

Controlled. mental health screenings


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16685
TITLE: Day care licensing public health nurse review records
DATES:
ARRANGEMENT:

DESCRIPTION: This inspection form documents the separate annual review of day care centers by public health nurses prior to their state licensing and the relicensing. The form includes center's name, address, owner and person in charge; visit date, arrival and departure times, public health nurse's signature, department's name, indication of review of program and records, and recommendations and comments.

RETENTION

Retain until facility no longer licensed

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office until no longer licensed and then destroy.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 23.

PRIMARY DESIGNATION

Public


AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16686
TITLE: Immunization cards
DATES:
ARRANGEMENT:

DESCRIPTION: These cards document immunization given by the local health department. They include name, birthdate, sex, address, phone number, type of immunizations, series, date given, and date booster given. Some cards also include the signature of the parent. In 1991, the card was replaced with the immunization record and signature card. The new card records similar information, but also serves as the immunization informed consent card.

RETENTION

Retain 10 years after date of last immunization

DISPOSITION

Destroy.

FORMAT MANAGEMENT

Paper: Retain in Office for 10 years after last visit and then destroy provided client has reached the age of 21.

APPRAISAL

This disposition is based on Utah County General Records Retention Schedule, Schedule 25, Item 45.

PRIMARY DESIGNATION

Private