JOINT CIRCULAR

REGULATIONS ON HEALTHCARE ACTIVITIES IN SCHOOLS

Pursuant to the Government’s Decree No.63/2012/ND-CP on functions, entitlement, responsibilities and organizational structures of Ministry of Health dated August 31, 2012;

Pursuant to the Government’s Decree No.32/2008/ND-CP on functions, entitlement, responsibilities and organizational structures of the Ministry of Education and Training dated March 19, 2008;

Pursuant to the Directive No.23/2006/CT-TTg on healthcare in educational institutions dated July 12, 2006 by the Prime Minister;

The Minister of health and Minister of Education and Training hereby issues this Joint Circular stipulating regulations on healthcare activities in schools.

Chapter I

GENERAL PROVISIONS

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1. This Joint Circular stipulates regulations on healthcare activities in schools in respects of facilities, equipment, environment and other healthcare services for students.

2. This Joint Circular applies to preschool education institutions, primary schools, lower secondary schools , upper secondary school, combined schools,  specialty schools excluding reform schools or schools for the disabled (hereinafter referred to as “school”) and relevant entities.

Article 2. Interpretation of terms

For the purposes of this Joint Circular, terms herein shall be construed as follows:

1. School hygiene refers to conditions of the study environment, facilities in schools and classrooms, teaching tools, hygienic conditions for teaching, studying, physical practice and healthcare .

2. Compulsory schooling disease refers to a disease that student mat suffer from due to poor hygienic conditions in schools.

Article 3. Sources of financing for healthcare activities in schools

1. Healthcare  activities in schools are financed from:

a) Annual funding for health and education allocated according the current budget of the organization;

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c) Funding from domestic and overseas entities and other legal earnings under regulations of laws.

2. The funding for healthcare activities in schools shall be properly allocated in accordance with the State’s current regulations of laws.

3. The estimation, allocation and finalization of such funding shall be made in accordance with current regulations of laws.

Chapter II

REQUIREMENTS FOR HEALTHCARE ACTIVITIES IN SCHOOLS

Article 4. Requirements for classrooms, student desks, chalkboards, lighting systems and toys in schools

1. Classrooms

a) For preschool education institutions:

Every classroom of preschool education institutions (hereinafter referred to as “preschool”)  shall satisfy the design requirements stipulated in item 5.2 of the Vietnam Standards 3907: 2011( hereinafter referred to as “TCVN” ) issued together with the Decision No.2585/QD-BKHCN on publishing national standards dated August 23, 2011 by the Minister of Science and Technology (hereinafter referred to as Decision No.2585/QD-BKHCN);

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Every classroom in above-mentioned schools shall satisfy the design requirements stipulated in item 5.2 of TCVN 8793: 2011 issued together with the Decision No.2585/QD-BKHCN;

c) For lower secondary schools; upper secondary school; and classrooms for upper and lower high school students in combined schools and specialty schools:

Every classroom of above-mentioned school shall satisfy the designed requirements stipulated in item 5.2 of TCVN 8794: 2011 issued together with the Decision No.2585/QD-BKHCN.

2. Student desks and chairs

a) For preschool education institutions:

The dimension of student desks shall conform to  TCVN 1993: Desks and chairs for preschoolers – general requirements;

b) For primary schools, lower secondary schools; upper secondary school, combined schools and specialty schools:

The dimension of student desks and chairs shall conform to the Joint Circular No.26/2011/TTLT-BGDDT-BKHCN-BYT on guidelines for standards of student desks and chairs in primary schools, lower secondary schools and upper secondary school.

3. Chalkboards in high schools

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b) Every chalkboard shall be 1.2 – 1.5 m in width and 2.0 – 3.2 m in length;

c) Every chalkboard shall be put up in the middle of the wall, the distance from lower edge of the chalkboard to the classroom floor shall be 0.8 – 1.0m (for lower secondary schools and upper secondary school) and the distance from the chalkboard to the first-row desk shall be at least 1.8 m.

4. Lighting systems

For preschools:

The lighting system shall be designed in  conformity with  the TCVN 3907:2011 issued together with the Decision No.2585/QD-BKHCN;

b) For primary schools, primary classrooms in combined schools and specialty schools:

The lighting system shall be designed in  conformity with  requirements in item 6.2 of  the TCVN 8793: 2011 issued together with the Decision No.2585/QD-BKHCN;

c) For lower secondary schools; high schools; classrooms for junior or senior high school students in combined schools and specialty schools:

The lighting system shall be designed in  conformity with  requirements in item 6.2 of TCVN 8794: 2011 issued together with the Decision No.2585/QD-BKHCN.

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Every preschool toy shall be conformable to the Circular No.16/2011/TT-BGDDT on provision, management and utilization of preschool toys  dated April 13, 2011 by the Minister of Education and Training.

Article 5. Requirements for water supply and drainage and environmental hygiene in schools

1. Drinking water and domestic water supply

a) Every school shall supply  sufficient drinking water  in a quantity of at least 0.5 liter per student/class in summer and 0.3 liter per student/class in winter;

b) Every school supply sufficient domestic water in a quantity of at least 5 liters per student/class.   If the domestic water is distributed through pipelines, each nozzle shall be designed to meet the need of not exceeding 200 students per class;

c) Every boarding school shall  supply sufficient drinking water and domestic water in the minimum quantity of 100 liters per student per 24 hours;

d) The water shall be bought from facilities that are eligible to supply domestic and drinking water. In case of self-sufficiency of drinking water, the quality of drinking water shall satisfy national technical regulations (QCVN 6 -1:2010/BYT) dated June 17, 2009 by the Minister of Health on drinking water quality; the quality of mineral water and bottled water  shall satisfy the QCVN 6 -1:2010/BYT issued together with the Circular No.34/2010/TT-BYT dated June 02, 2010 by the Minister of Health on introduction of national technical regulations on mineral water and bottled water; and the quality of domestic water shall satisfy the QCVN 02:2009/BYT issued together with the Circular No.05/2009/TT-BYT  on introduction of national technical regulations on domestic water quality dated June 17, 2009 by the Minister of Health.

2. Sanitation infrastructures

a) With respect of design:

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Every sanitation infrastructure shall be designed in conformity with standards stipulated in item 5.2.7. and 5.5.8 of TCVN 3907:2011 issued together with the Decision No.2585/QD-BKHCN ;

- b) For primary schools, primary classrooms in combined schools and specialty schools:

Every sanitation infrastructure shall be designed in conformity with standards stipulated in items 5.6.1 and 5.6.2   and 5.6.3 of TCVN 8793:2011 issued together with the Decision No.2585/QD-BKHCN; ;

- c) For lower secondary schools; upper secondary school; classrooms for junior or senior high school students in combined schools and specialty schools:

Every sanitation infrastructure shall be designed in conformity with standards stipulated in item 5.6 of TCVN 8794:2011 issued together with the Decision No.2585/QD-BKHCN.

b) With respect of hygienic conditions of latrines:

Every latrines shall conform to the QCVN 01:2011/BYT issued together with the Circular No.27/2011/TT-BYT on issue of national technical regulations on latrines –hygienic conditions dated June 24, 2011 by the Minister of Health.

c) Every hand wash area shall be provided with clean water,  soap or antiseptics.

3. Waste collection and treatment

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b) Every school shall cooperate with qualified facilities to collect and treat wastes. In case that the school wishes to collect and treat wastes on their own, the collection and treatment shall be carried out in accordance with clause 4, section VII, part II of QCVN 07:2010/BYT- sanitation and hygiene for prevention of infectious diseases in national education system issued together with the Circular No.46/2010/TT-BYT  dated December19, 2010 by the Minister of Health on issue of the national technical regulations on sanitation and hygiene for prevention of infectious diseases in national education system (hereinafter referred to as “Circular No.46/2010/TT-BYT  ).

Article 6. Requirements for food safety

1. For schools with canteens for boarding students or semi-boarding students

a)The canteen shall have its facilities met all requirements for food safety prescribed clauses 1, 2 and 3, Section VI and hygiene requirements for food processing and storage promulgated in clause 5 of the QCVN 07:2010/BYT-prevention and control of infectious diseases in schools within the national education system issued together with the Circular No.46/2010/TT-BYT;

b) Every canteen in schools shall meet requirements stipulated in Article 4 of the Circular No.30/2012/TT-BYT on food safety and hygiene for food and beverage services and street vendors dated December 05, 2012 by the Minister of Health.

c) Every canteen staff shall meet health conditions prescribed in the Circular No. 15/2012/TT-BYT dated September 12th 2012 of the Ministry of Health on the general conditions for food safety applicable to establishments that produce and trade food.

2. For schools without canteens for boarding students or semi-boarding students entering into contracts with others that is certified satisfactory for food safety to provide meals for students; the canteen shall satisfy requirements in point b, clause 1 of this Article.

Article 7. Execution of school health policies and development of social relationships between schools and community

1. The Student Health Advisory Committee shall clarify member’s responsibilities and hold meetings at least once a semester.

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3. Deepen relationships between teachers and students, and between students , create healthy study environment without discrimination and violence.

4. Create school-parent and school – community relationships to facilitate school healthcare.

Article 8. Requirements for school’s first aid rooms and medical staff

1. For first aid rooms

a) Every school shall have their own first aid room that is situated in a convenient location and covers a required standard areas to facilitate the school health services.

b) Every first aid rooms of primary schools, lower secondary schools, upper secondary school, combined schools and specialty schools shall be equipped with at least 01 sickbed, working desk, chair, cabinet, scale, ruler, sphygmomanometer, thermometer, eye chart, splint and essential drugs for first aid and emergency administration and student healthcare under the Decision No.1221/QD-BYT  on lists of essential drugs and equipment used for first at rooms of primary schools, lower secondary schools, upper secondary schools and combined schools  dated April 07, 2008 by the Minister of Health. Every preschool shall be provided with specialized equipment and essential drugs according to students’ ages;

c) Every first aid room shall have health examination records using the form A1/YTCS  prescribed in the Circular No.27/2014/TT-BYT on medical reporting forms for medical facilities of provinces, districts and communes, health records for students using the form 01 and integrated health record using the form 02 in the Annex 01 herewith.

2. For school’s medical staff

a) Every medical staff shall acquire at least an associate degree in physician assistant. According to the reality, every school shall hire medical staff who meet the qualifications requirement or sign contract for school health with general medical stations or medical examination and treatment facilities;

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c) Medical staff shall consult school boards about the implementation of Articles 9 and 10 and other tasks assigned by the school board.

Article 9. School health management and education

1. Carry out health examination at the beginning of every academic year to assess student’s physical and nutritional status by measuring the  height and weight of students of under 36 months olds; and measuring the height and weight, blood pressure, heart rate and visual acuity of students of older 36 months old .

2. Monthly and quarterly measure  the height and weight and record  physical developmental milestone charts of under-24- month students and above-24-month students, respectively; measure BMI at least twice an academic year to provide advices on nutrition and physical exercises for high school students.

3. Regularly examine student’s health, visual acuity, curvature of spine, oral diseases, metal health and other diseases to cure and apply a proper learning environment and physical exercises.

4. Cooperate with qualified medical facilities to carry out specialty examination and treatment.

5. Administer first aid and emergency treatment under current regulations of the Minister of Health.

6. Provide students, their parents or guardians and teachers with advice on  common diseases, student physical and mental development and healthcare; in case of disabled students, assist them in inclusive education.

7. Provide instructions on healthy meal and diversified foods according to student’s age ( for boarding schools and semi-boarding schools)

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9. Notify students’ parrents or guardians of their child’s health at least once an academic year or where necessary. Medical staff shall assess students’ health status by the graduation as the basis for health recording in the higher level.

10. Record the student health in health examination record, health record and integrated health record.

11. Regularly inspect and supervise the study environment, school hygiene, food safety, drinking water and hand wash. Implement measures for preventing and controlling diseases under the Circular No.46/2010/TT-BYT  and other instructions of medical authorities.

12. Conduct medical programs and hygiene campaign, participate in physical exercises, healthy meal, and create smoke-free, alcohol-free and addictive-free schools.

Article 10.Health education

1. Compile and use documents on health education according to student age and the local reality.

2. Educate students, their parents or guardians about infectious disease and food poisoning prevention measures ; nutrition, physical exercises, cigarette and alcohol effect, compulsory schooling diseases, oral health, eye  diseases and other injuries; propagate and participate in health education programs launched by the Ministry of Health and Ministry of Health and Training.

3. Include health education in lectures.

4. Get students participate in personal hygiene, school and environment cleaning, infectious healthy meal, physical exercises, prevention of tobacco and alcohol adverse effects, compulsory schooling diseases, eye diseases  and injuries via proper models and methods

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1. Periodic and irregular reports

a) Submit annual reports using the form in Annex 02 herewith to the medical station of the commune, Division of Education and Training and Department of Education and Training by May 10 of every academic year.

b) Submit irregular reports at request of superior authorities.

2. Assessment of healthcare activities in schools

Every school shall carry out self-assessment of school health performance by the end of academic year  using the form 03 in the Annex herewith (for preschool education institutions) or the form in the Annex 04 herewith (for primary schools; lower secondary schools, high schools, combined schools and specialty schools).

Chapter III

IMPLEMENTATION ORGANIZATIONS

Article 12. Responsibilities of schools

Every school shall:

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2. Supervise, inspect and provide instructions on the implementation of school health.

3.  Provide necessary facilities, equipment and drugs for medical staff to conduct school health services.

4. Request competent authorities to provide medical staff for school healthcare.

5. Set up Student Health Advisory Board in which the school board’s representative plays as the Chief, Head of  medical station of commune as Deputy chief, school medical staff as standing members, physical teachers, teacher in charge of Ho Chi Minh Young Pioneer Organization of the school (for primary and lower secondary schools) and representatives of Communist Youth Union of Ho Chi Minh City, school’s red cross and Parent-Teacher Association as members.

6. Consult competent authorities about current regulations and standards in case of construction, renovation, purchase of equipment, teaching tools, preschool toys, medical facilities and drugs.

Article 13. Responsibilities of medical stations of communes

Every medical station of communes shall:

1. Include school health plans in the general health plan of the commune.

2. Assign personnel to supervise the school health and support school’s medical staff in medical profession to fulfill responsibilities stipulated in this Circular.

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Article 14. Responsibilities of Divisions and Departments of Education and Training

Every Division and Department of Education and Training shall:

1. Cooperate with health authorities of communes and People’s Committees at all levels to draw up school health plans and execute such plans within their jurisdiction.

2. Expedite, supervise and inspect school health implementation under this Joint Circular.

3. Cooperate with health authorities to provide school’s medical staff with training courses in school health.

4. Cooperate with local authorities to carry out annual assessment of health school within their jurisdiction.

5. Submit statistics and reports on school health under regulations of laws.

6. Have school’s medical staff recruited in accordance with regulations of competent authorities.

7. Consult competent authorities about current regulations and standards in case of construction, renovation, purchase of equipment, teaching tools, preschool toys, medical facilities and drugs.

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Every medical center of districts and preventive medical center of provinces and  Department of Health shall:

1. Take charge of and cooperate with education authorities to assist People’s Committees at all levels in preparation of school health plans and provision of instruction on plan execution within their jurisdiction.

2. Cooperate with education authorities to provide school’s medical staff with training courses in school health and instructions on management, propagation  and education of healthcare.

3. Inspect and supervise the school and environmental hygiene, student health education and other relevant aspects.

4. Submit school health statistics and reports under regulations of laws.

Article 16. Responsibilities of affiliates of the Ministry of Health and Ministry of  Education and Training

1. The General Department of Preventive Medicines the focal authority of the Ministry of Health; and student Affairs as the focal authority of the Ministry of Education and Training shall take charge of executing provisions hereof.

2. Every affiliates of the Ministry of Education and Training, and Ministry of Health shall prepare school health plans, execute such plans and report the achievements and limitations according to the jurisdiction.

Article 17. Responsibilities of People’s Committees at all levels

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1. Approve annul school health plans prepared by schools within their administration, proactively provide schools with funding, personnel and faculties for healthcare.

2. Establish Steering Committees of school health in which the Head of the People’s Committee plays as the Chief, Head of education authorizes and health authority play as deputy chiefs, heads of departments of finance, department of homer affairs, department of investment and planning, departments of social insurances, preventive medical centers of provinces and destructs and relevant agencies play as members; or assign People’s Healthcare Committee of the same level to take charge of school health, and define functions and responsibilities of each members. 

3. Mobilize resources to upgrade facilities and school environment, study conditions and health conditions within their administration under regulations of laws.

4. Direct regulatory authorities to participate in school health services within the administration.

5. Approve and provide instructions on planning, renovation and purchase of equipment, teaching tools, medical facilities according to current regulations and standards.

6. Introduce preferential policies on school's medical staff.

Chapter IV

IMPLEMENTATION

Article 18. Reference clauses

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Article 19. Entry into force

1. This Circular enters into force from June 30, 2016.

2. As its effective date, this Joint Circular replaces Article 4 of the regulation of healthcare in preschool education institutions issued together with the Decision No.58/2008/QD-BGDDT dated October 17, 2008 by the Minister of Education and Training; Article 4 of the regulation in healthcare in primary schools, lower secondary schools, high schools and combined schools issued together with the Decision No.73/2007/QD-BGDDT  dated December 04, 2007 by the Minister of Education and Training; Decision No.1221/2000/QD-BYT dated April 28, 2000 by the Minister of Health; Joint Circular No.18/2011/TTLT-BGDDT-BYT on assessment of healthcare in primary school, lower secondary schools, high schools and combined schools  dated April 18, 2011 by the Minister of Education and Training and Minister of Health; Joint Circular No.22/2013/TTLT-BGDDT-BYT on assessment of healthcare in preschool education institutions dated June 18, 2013 by the Minister of Education and Training and Minister of Health, and relevant provisions of assessment of healthcare in preschools, lower secondary schools and high schools prescribed in the Joint Circular No.03/2000/TTLT-BYT-BGDDT dated March 01, 2000 by the Minister of Education and Training and Minister of Health.

Article 20. Transitional provisions

Every operating school shall have satisfied requirements for planning, design and construction according current standards and regulations by January 01, 2020.

Any issue arising from the implementation of this Circular should be reported to the Student Affairs – Ministry of Education and Training and General Department of Preventive Medicine- Ministry of Health./.

PP. MINISTER OF EDCUATION AND TRAINING
DEPUTY MINISTER




Nguyen Thi Nghia

PP. MINISTER OF HEALT
DEPUTY MINISTER





Nguyen Thanh Long

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LIST OF ANNEXES

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 22, 2016 by the Minister of Education and Training and Minister of Health)

Annex 01. Forms for   health records and integrated  health records

Form 01. Health record

The health record is made in A5 size (14.8cm x 21cm). The school shall select one of the following health record forms according to student age:

- Health record for students from 03 months to under 06 years old

- Health record for students  from first grade to fifth grade.

- Health record for students from sixth grade to ninth grade.

- Health record for students from tenth grade to twelfth grade.

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Annex 02. School health report form

Annex 03.Assessment of healthcare activities in schools  (for preschool education institutions)

Annex 04.Assessment of healthcare activities in schools  (for high schools)

Made in A5 (14.8cm x 21cm)

ANNEX 01

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 12, 2016 by the Minster of Education and Training)

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THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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HEALTH RECORD

Full name (uppercase)…………..………... Male  □  Female  □

Date of birth:………………………………………

School name:……………………………………...……………….

District: ………………….……………….

Province:………………….……………….

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For preschoolers
(From 03 months to under 6 years old)

(This record shall be kept during the preschool age, in case of school transfer, the student shall submit this record to the new school)

The back cover

PART I – GENERAL INFORMATION

(To be completed by student’s parents )

1. Student full name (upper case):………….……………………….. Male  □  Female  □

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3. Full name of father/guardian :.....................................................................................  

Occupation...................................................................... Contact number.....................

Current residential address:....................................................................................... 

4.  Full name of mother/guardian:................................................................................... 

Occupation............................................................................... Contact number............

Current residential address:....................................................................................... 

5. Birth order:…………………………….. Total number of children::………………………  

6. Health history:..................................................................................................  

Obstetrics

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- Abnormal: Preterm birth   □  Postmature birth  □ Medical interventions during labour □  Prenatal asphyxia □

- Diseases in pregnancy (specify): ..............................................

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b) History of diseases: Asthma □   epilepsy □ Allergy □   Congenital heart diseases  □

c) Immunization

No.

Vaccines

Vaccination

Yes

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Not sure

1

BCG

2

Diphtheria, pertussis and tetanus

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Second dose

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3

Polio vaccine

First dose

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Second dose

Third dose

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4

Hepatitis B

Infants

First dose

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Second dose

Third dose

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5

Measles

6

Japanese Encephalitis B

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First dose

Second dose

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Third dose

7

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7. Changes in residential address or contact number (if any)...........................................

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SCHOOL NAME:..............................................................................................................  

FULLNAME OF STUDENT...............................................................................................

(For under-24 – month students)

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

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CLASS…………………………………….. ACADEMIC YEAR ……………………………………..

Date.............

Examining doctor
(signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

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Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

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Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

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Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

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Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

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Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

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Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

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Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Nutrition:

- Well-nourished                 □

- Malnuourished           □

- Obese                □

Nutrition:

- Well -noursihed                □

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- Obese                □

SCHOOL NAME:..............................................................................................................  

FULLNAME OF STUDENT...............................................................................................

(For students from 24 months to under 26 months old)

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

1. Physical examination ( First examination – at the beginning of an academic year, Second examination - at the middle of an academic year, Third examination - At the end of an academic year)

CLASS…………………………………….. ACADEMIC YEAR ………………………………

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Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

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Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

Third examination

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Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

SCHOOL NAME:................................................................................................................

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(For students from 36 months to under 6 years old)

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

1. Physical examination ( First examination – at the beginning of an academic year, Second examination - at the middle of an academic year, Third examination - At the end of an academic year)

CLASS…………………………………….. ACADEMIC YEAR ………………………………

First examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

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Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

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Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

Third examination

Examining doctor
(Signature and full name)

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- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

CLASS…………………………………….. ACADEMIC YEAR ………………………………

First examination

Examining doctor
(Signature and full name)

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- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Without glasses: Right eye:……./10   Left eye:……./10  

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Second examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

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Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

CLASS…………………………………….. ACADEMIC YEAR ………………………………

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Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

- Obese                □

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

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Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

...

...

...

- Obese                □

Third examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished      □

- Malnourished        □

...

...

...

2. Abnormalities

Date

Initial diagnosis

Treatment

Remarks

At school
(specify  treatments )

Referral to
(specify receiving facility)

……/…../………

...

...

...

……/…../………

……/…../………

...

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...

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...

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……/…../………

……/…../………

...

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……/…../………

……/…../………

...

...

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……/…../………

PART 3 –  HEALTH SPECIALTY EXAMINATION

(To be completed by specialty physicians or doctors)

...

...

...

Paediatrics

a) Cardiovascular
………………………………………………………………….

…………………………………………………………………………………..

b) Respiratory: ………………………………………………….…………….

…………………………………………………………………………………..

c) Gastrointestinal……………………………………………………………..

d) Renal-urinary …………………………………………………………….

…………………………………………………………………………………..

...

...

...

e) Others………………………………………………………………………

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Eyes

a)Vision test:

- Unaided: Right eye:……./10   Left eye:……./10  

- Aided:       Right eye:……./10   Left eye:……./10  

b) Eye diseases (if any)
………………………………………………..

...

...

...

…………………………………………………………………………………..

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Ear-Nose-Throat

a)Hearing test:

- Left ear:   Conversational voice::…….. m; whispered  voice:…….m

- Right ear: Conversational voice::…….. m; whispered  voice:…….m

b) Other related diseases (if any)……………………………………………..

...

...

...

Oral and maxillofacial system

Oral and maxillofacial test

- Maxilla……………………………………………………………………..

…………………………………………………………………………………..

-Mandible……………………………………………………………………..

…………………………………………………………………………………..

b)  Oral maxillofacial pathology (if any)……………………………………..

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

...

...

...

a)Musculoskeletal test

- Normal                  □

- Curvature:  Kyphosis □  Lordosis □

- Scoliosis: S-line   □   C-line  □

b) Other musculoskeletal disorders (if any)………………………………

…………………………………………………………………………………..

…………………………………………………………………………………..

...

...

...

Annex 01

FORM 01. HEALTH RECORD

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on healthcare in schools dated May 12, 2016 by the Minster of Education and Training)

The front cover

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

...

...

...

Full name (uppercase)…………..………... Male  □  Female  □

Date of birth:………………………………………

School name:……………………………………...……………….

District: ………………….……………….

Province:………………….……………….

For students from the first grade  to fifth grade

...

...

...

(This record shall be kept during the primary school age, in case of school transfer, the student shall submit this record to the new school)

The back cover

PART I – GENERAL INFORMATION

(To be completed by student’s parents)

1. Full name of student (upper case):……………………………….. Male  □  Female  □

2. Date of birth:………………………………………

3. Full name of father/guardian :................................................................................... 

Occupation................................................ Contact number..........................................

...

...

...

4. Full name of mother/guardian :.................................................................................... 

Occupation................................................ Contact number..........................................

Current residential address:.......................................................................................

5. Birth order:…………………………….. Total number of children::………………………  

6. Health history:..................................................................................................   

a)Obstetrics:

- Normal      □

- Abnormal: Preterm birth   □  Postmature birth  □ Medical interventions □  Prenatal asphyxia □

- Diseases in pregnancy (specify): ..............................................

...

...

...

b) History of diseases: Asthma □   Epilepsy □ Allergy □   Congenital heart diseases  □

c) Immunization:

No.

Vaccines

Vaccination

Yes

No

Not sure

1

...

...

...

2

Diphtheria, pertussis and tetanus

First dose

...

...

...

Second dose

Third dose

...

...

...

3

Polio

First dose

Second dose

...

...

...

Third dose

4

Hepatitis B

...

...

...

Infants

First dose

...

...

...

Second dose

Third dose

...

...

...

Measles

6

Japanese Encephalitis B

First dose

...

...

...

Second dose

Third dose

...

...

...

7

…..

d) If in any treatment or on medication, please state diseases and drug name:         

..........................................................................................................................................

7. Changes in residential address or contact number (if any)..........................................

...

...

...

SCHOOL NAME:.............................................................................................................

FULLNAME OF STUDENT.............................................................................................

PART II – PHYSICAL EXAMINATION

(To be completed by school’s examining doctors)

1. Examination of appearance, blood pressure, heart rate and vision (first examination – at the beginning of an academic year, Second examination -  at the beginning of the second Semester)

FIRST GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

...

...

...

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

...

...

...

SECOND GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m2)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

...

...

...

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

THIRD GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

...

...

...

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

FOURTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

...

...

...

                Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

...

...

...

First examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

...

...

...

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

2. Abnormalities

Date

Initial diagnosis

Treatment

Remarks

At school
(specify  treatments)

Referral to
(specify receiving facility)

...

...

...

……/…../………

...

...

...

...

...

...

……/…../………

...

...

...

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...

……/…../………

...

...

...

(To be completed by specialty physicians or doctors)

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Paediatrics

a) Cardiovascular
………………………………………………………………….

…………………………………………………………………………………..

b) Respiratory: ………………………………………………….………………….

…………………………………………………………………………………..

c) Gastrointestinal…………………………………………………..…………

…………………………………………………………………………………..

...

...

...

…………………………………………………………………………………..

dd) Neurologic - Psychiatric………………………………………………………

…………………………………………………………………………………..

e) Others…………………………………………………………………………

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Eyes

a)Vision test:

- Unaided: Right eye:……./10   Left eye:……./10  

...

...

...

b) Eye diseases (if any)
………………………………………………..

…………………………………………………………………………………..

…………………………………………………………………………………..

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Ear-Nose-Throat

a)Hearing test:

- Left ear:   Conversational voice::…….. m; whispered  voice:…….m

- Right ear: Conversational voice::…….. m; whispered  voice:…….m

b) Other related diseases (if any)……………………………………………

...

...

...

…………………………………………………………………………………..

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Oral and maxillofacial system

a)Oral and maxillofacial examination:

- Maxilla……………………………………………………………………..

…………………………………………………………………………………..

-Mandible……………………………………………………………………..

…………………………………………………………………………………..

b)  Oral maxillofacial pathology (if any)……………………………………..

...

...

...

…………………………………………………………………………………..

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Musculoskeletal system

a)Musculoskeletal test

- Normal                  □

- Curvature:  Kyphosis □  Lordosis □

- Scoliosis Scoliosis: S-shaped   □   C-shaped  □

b) Other musculoskeletal disorders (if any)………………………………

…………………………………………………………………………………..

...

...

...

Made in A5 (14.8cm x 21cm)

Annex 01

FORM 01. HEALTH RECORD

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 12, 2016 by the Minister of Education and Training)

The front cover

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

...

...

...

HEALTH RECORD

Full name (uppercase)…………..………... Male  □  Female  □

Date of birth:………………………………………

School name:……………………………………...……………….

District: ………………….……………….

Province:………………….……………….

...

...

...

For students from sixth  grade  to ninth grade

(This record shall be kept during the junior school age, in case of school transfer, the student shall submit this record to the new school)

The back cover

PART I – GENERAL INFORMATION

(To be completed by student’s parents)

1. Full name of student (upper case):…………………………….. Male  □  Female  □

...

...

...

3. Full name of student’s father/guardian :.................................................................... 

Occupation................................................ Contact number..........................................

Current residential address:....................................................................................... 

4. Full name of student’s mother/guardian :.................................................................. 

Occupation................................................ Contact number..........................................

Current residential address:....................................................................................... 

5. Birth order:…………………………….. Total number of children::……………………  

6. Health history:..................................................................................................   

a)Obstetrics:

...

...

...

- Abnormal: Preterm birth   □  Postmature birth  □ Medical interventions during labour □  Prenatal asphyxia □

- Diseases in pregnancy (specify): ..............................................

..........................................................................................................................................

b) History of diseases: Asthma □   Epilepsy □ Allergy □   Congenital heart diseases  □

c) Immunization:

No.

Vaccines

Vaccination

Yes

...

...

...

Not sure

1

BCG

2

Diphtheria, pertussis and tetanus

...

...

...

Second dose

...

...

...

3

Polio

First dose

...

...

...

Second dose

Third dose

...

...

...

4

Hepatitis B

Infants

First dose

...

...

...

Second dose

Third dose

...

...

...

5

Measles

6

Japanese Encephalitis B

...

...

...

First dose

Second dose

...

...

...

Third dose

7

…..

...

...

...

.........................................................................................................................................

7. Changes in residential address or contact number (if any)..........................................

SCHOOL NAME:.............................................................................................................  

FULLNAME OF STUDENT..............................................................................................

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

1. Examination of appearance, blood pressure, heart rate and vision (first examination – at the beginning of an academic year, Second examination -  at the beginning of the second Semester)

SIXTH GRADE………………….. ACADEMIC YEAR…………………..

...

...

...

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

...

...

...

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

SEVENTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

...

...

...

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

EIGHTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status: Height:………m; Weight:………kg;

...

...

...

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

NINTH GRADE………………….. ACADEMIC YEAR…………………..

...

...

...

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

Examining doctor
(Signature and full name)

...

...

...

                Body Mass Index (BMI):………………….. (kg/m²)

2. Abnormalities

Date

Initial diagnosis

Treatment

Remarks

At school
(specify  treatments)

Referral to
(specify receiving facility)

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

……/…../………

...

...

...

……/…../………

PART 3 –  HEALTH SPECIALTY EXAMINATION

...

...

...

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Paediatrics

a) Cardiovascular
………………………………………………………………….

…………………………………………………………………………………..

b) Respiratory: ………………………………………………….………………….

…………………………………………………………………………………..

c) Gastrointestinal…………………………………………………..…………

…………………………………………………………………………………..

d) Renal-urinary …………………………………………………………….

...

...

...

dd) Neurologic - Psychiatric………………………………………………………

…………………………………………………………………………………..

e)Others……………………………………………………………………………

…………………………………………………………………………………..

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Eyes

a)Vision test:

- Unaided: Right eye:……./10   Left eye:……./10  

- Aided:       Right eye:……./10   Left eye:……./10  

...

...

...

…………………………………………………………………………………..

…………………………………………………………………………………..

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Ear-Nose-Throat

a)Hearing test:

- Left ear:   Conversational voice::…….. m; whispered  voice:…….m

- Right ear: Conversational voice::…….. m; whispered  voice:…….m

b) Other related diseases (if any)……………………………………………

…………………………………………………………………………………..

...

...

...

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Oral and maxillofacial system

a)Oral and maxillofacial examination:

- Maxilla……………………………………………………………………..

…………………………………………………………………………………..

-Mandible……………………………………………………………………..

…………………………………………………………………………………..

b)  Oral maxillofacial pathology (if any)……………………………………..

…………………………………………………………………………………..

...

...

...

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Musculoskeletal system

a)Musculoskeletal test

- Normal                  □

- Curvature:  Kyphosis □  Lordosis □

- Scoliosis S-shaped   □   C-shaped  □

b) Other musculoskeletal disorders (if any)………………………………

…………………………………………………………………………………..

…………………………………………………………………………………..

...

...

...

Made in A5 (14.8cm x 21cm)

Annex 01

FORM 01. HEALTH RECORD

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on healthcare in schools dated May 12, 2016 by the Minster of Education and Training)

The front cover

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

...

...

...

HEALTH RECORD

Full name (uppercase)…………..………... Male  □  Female  □

Date of birth:………………………………………

School name:……………………………………...……………….

District: ………………….……………….

Province:………………….……………….

...

...

...

(This record shall be kept during the preschool age, in case of change of the school, the student shall submit this record to the new school)

The back cover

PART I – GENERAL INFORMATION

(To be completed by student’s parents)

1. Full name of student (upper case):…………………………….… Male  □  Female  □

2. Date of birth:………………………………………

...

...

...

Occupation................................................ Contact number..........................................

Current residential address:....................................................................................... 

4. Full name of student’s mother/guardian :................................................................... 

Occupation................................................ Contact number..........................................

Current residential address:....................................................................................... 

5. Birth order:…………………………….. Total number of children::………………………   

6. Health history:..................................................................................................   

a)Obstetrics:

- Normal      □

...

...

...

- Diseases in pregnancy (specify): ..............................................

.........................................................................................................................................

b) History of diseases: Asthma □   Epilepsy □ Allergy □   Congenital heart diseases  □

c) Immunization:

No.

Vaccines

Vaccination

Yes

No

...

...

...

1

BCG

2

Diphtheria, pertussis and tetanus

First dose

...

...

...

Second dose

Third dose

...

...

...

3

Polio

First dose

...

...

...

Second dose

Third dose

...

...

...

Hepatitis B

Infants

First dose

...

...

...

Second dose

Third dose

...

...

...

5

Measles

6

Japanese Encephalitis B

...

...

...

Second dose

...

...

...

7

…..

d) If under any treatment or on medication, please state diseases and drug name:         

...

...

...

7. Changes in residential address or contact number (if any)..........................................

SCHOOL NAME:...............................................................................................................  

FULLNAME OF STUDENT.................................................................................................

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

1. Examination of appearance, blood pressure, heart rate and vision (first examination – at the beginning of an academic year, Second examination -  at the beginning of the second Semester)

TENTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

...

...

...

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided:       Right eye:……./10   Left eye:……./10  

Second examination

Examining doctor
(Signature and full name)

...

...

...

                Body Mass Index (BMI):………………….. (kg/m²)

ELEVENTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure: Diastolic ……./mgHg   Systolic……/mgHg

Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

...

...

...

Second examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

TWEFTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

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Heart rate:……….bpm

Vision test: Unaided: Right eye:……./10   Left eye:……./10  

              Aided: Right eye:……./10   Left eye:……./10       

Second examination

Examining doctor
(Signature and full name)

Physical status: Height:………m;  Weight:………kg;

                Body Mass Index (BMI):………………….. (kg/m²)

2. Abnormalities

Date

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Treatment

Remarks

At school
(specify  treatment methods)

Referral to
(specify receiving facility)

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(To be completed by specialty physicians or doctors)

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Paediatrics

a) Cardiovascular
………………………………………………………………….

…………………………………………………………………………………..

b) Respiratory: ………………………………………………….………………….

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c) Gastrointestinal…………………………………………………..……………

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dd) Neurologic - Psychiatric………………………………………………………

…………………………………………………………………………………..

e)Others……………………………………………………………………………

…………………………………………………………………………………..

Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Eyes

a)Vision test:

- Unaided: Right eye:……./10   Left eye:……./10  

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b) Eye diseases (if any)
………………………………………………..

…………………………………………………………………………………..

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Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Ear-Nose-Throat

a)Hearing test:

- Left ear:   Conversational voice::…….. m; whispered  voice:…….m

- Right ear: Conversational voice::…….. m; whispered  voice:…….m

b) Other related diseases (if any)……………………………………………

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Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Oral and maxillofacial

a)Oral and maxillofacial examination:

- Maxilla……………………………………………………………………..

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-Mandible……………………………………………………………………..

…………………………………………………………………………………..

b)  Oral maxillofacial pathology (if any)……………………………………..

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Date of examination …./…./…….Examining physician/doctor
(Signature and full name)

Musculoskeletal system

a)Musculoskeletal test

- Normal                  □

- Curvature:  Kyphosis □  Lordosis □

- Scoliosis S-shaped   □   C-shaped  □

b) Other musculoskeletal disorders (if any)………………………………

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Made in A4 (21cm x 29.7cm)

Annex 01

FORM 02. INTEGRATED HEALTH RECORD

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 12, 2016 by the Minister of Education and Training and Minister of Health)

The front cover

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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INTEGRATED HEALTH RECORD

SCHOOL NAME:..........................................................................

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Province………………………..

LIST OF MALNOURISHED STUDENTS

ACADEMIC YEAR:………………………………..

No.

Student’s full name

Gender

Grade

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Treatment

Remarks

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Female

At school (specify treatments)

Referral to
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LIST OF OVERWEIGHT OR OBESE STUDENTS

ACADEMIC YEAR:………………………………..

No.

Student’s full name

Gender

Grade

Date of discovery

Diagnosis

Treatment

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