AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16677
TITLE: Child health evaluation care (CHEC) target area records
DATES: undated
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 for 3 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series is proposed and has not yet been approved.

FORMAT MANAGEMENT

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

APPRAISAL

PRIMARY DESIGNATION

Private

---