AGENCY: Davis County (Utah). Health Department. Nursing Division

SERIES: 10955
TITLE: United Way dental service patient referral card
DATES: 1978-2015.
ARRANGEMENT: Alphabetical by head of household's name

DESCRIPTION: This card documents the referral of indigent children to dentists within Davis County. A new card is completed each time a referral is made. This program is funded by the United Way. This card includes dentist name, address, and telephone number, head of household's name, address, social security number, race, and telephone number, a listing of the names, sex, birth dates, dental problems, and medical problems of all family members, signatures of parents or guardian, name of public health nurse or social worker, name of agency, authorizing signature and date, amount of family co-payment, indication of income providing amount and frequency, whether father is unemployed and length of unemployment, a listing of debts, and any additional comments.

RETENTION

Retain for 3 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

FORMAT MANAGEMENT

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

APPRAISAL

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

PRIMARY DESIGNATION

Private

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