School-Based Health Centers - Implementation Tools
Seattle-King County Department of Public Health

Cover Letter

Welcome to the 1996-1997 school year! We would like to share information with you about the Teen Health Centers in the Seattle Public Schools and encourage you to enroll your child in the Teen Health Centers, if you have not done so in the past.

The Teen Health Centers are located in eight high schools (Cleveland, Franklin, Garfield, Nathan Hale, Sealth, Rainier Beach, Roosevelt, West Seattle) and serve students from 8 high schools, 2 middle schools (Madison and Denny), and 3 alternative schools (Summit 6-12 grades, Nova, and Marshall). The Teen Healtl1 Centers provide comprehensive, high quality services to keep students physically and mentally healthy. Each Teen Health Center is staffed by a full-time Nurse Practitioner, a Mental Health Counselor, and a Receptionist/Patient Care Coordinator. All are trained to work especially with adolescents.

Various community health agencies operate the Teen Health Centers. The Seattle-King County Department of Public Health coordinates and oversees the Teen Health Centers.

Before providing services to a student, Teen Health Centers must have a signed consent from a parent or legal guardian, except in situations where federal and/or state laws allow teens to access treatment without parent/guardian consent (e.g., reproductive health care, drug/alcohol and mental health counseling). This policy was developed with the Seattle Public Schools to ensure that the Teen Health Centers follow federal and state laws.

Student consent is legally required for release of information about reproductive health care, drug/alcohol and mental health counseling. However, staff at the Teen Health Centers are committed to encouraging family communication about healtl1 issues. We encourage students to provide their consent for us to involve parents whenever possible.

In the next month or two, you will receive additional information from the Teen Health Center that serves the school your student attends. In the meantime, please feel free to call the Seattle-King County Department of Public Health at 296-4987 or 205-9177 if you have questions or would like more information.

We welcome your student -- and you -- to the Teen Health Centers and look forward to ensuring a safe and healthy school year.

Parental Consent Form

Seattle-King County Department of Public Health

I understand that, in accordance with Seattle School District policy, Teen Health Centers must have a signed consent from a parent or legal guardian before providing services to teens, except in situations where federal and/or state laws allow students to access such treatment without parent/guardian consent (e.g., reproductive health care, drug/alcohol and mental health counseling). I understand that if I choose not to enroll my child in the Teen Health Centers, he/she will continue to receive school nurse services. I hereby request and authorize that

receive any and all health care services available from and deemed necessary by the staff of the Teen Health Center and its provider agencies listed above. These services may include, but are not limited to, such procedures as well teen care, evaluation and treatment of acute illnesses and injuries, immunizations, contraception, blood studies, photographs and X-rays. Consent is specifically given for care in the event the above named student presents him/herself for treatment in my absence. I understand the student's consent is legally required for release of information about the following kinds of diagnoses and treatment: pregnancy, sexually transmitted diseases (including HIV/AIDS testing), and alcohol and drug or mental health counseling. I understand, however, that I will be informed if the Teen Health Center staff feels the student is a danger to him/herself or others.

Consent is also given for referral of care and if needed, emergency transportation, to other physicians, health care professionals, hospitals, clinics, or health care agencies as deemed necessary by the Teen Health Center and its staff. Consent is given to contact such persons or agencies for the purpose of providing or receiving information and records relative to the above listed student.

This authorization does not allow services to be rendered without the student's consent, unless unable to consent.

The consent for services is authorized for the length of time the student is enrolled in a school with a Teen Health Center. I may choose to withdraw the consent at any time by writing to the Teen Health Center that serves the student.

[top]

Please provide the following student information. This information will be used for understanding who the teen health center serves. The information will also help the teen health center better serve its clients. This information is confidential. We will not give out this information with the student's name. Thank you for your cooperation!

Please circle the correct information:

1. Gender of the student

2. Grade of the student

3. Ethnicity of the student (check only one)

[top]