Girl at the Pediatrician
Module 3: School-Based Health Center Operations

This module reviews the initial implementation of a new school-based health center program and provides the necessary resources to begin the process of opening a new school-based health center. The tools in this module provide samples of parental forms, job descriptions, marketing, and other initial steps to opening a new health center.

REGISTRATION/PARENTAL CONSENT FORMS

SBHC Registration SBHC Packet (English and Spanish)

SBHC registration material in English and Spanish that discusses services are offered, services not offered, who provides services, parental involvement, confidentiality, costs, and insurance information. - Denver Health and Hospital

Student Enrollment and Registration Form (English)

Registration and consent form that enrolls a student in the SBHC physical, mental, and oral health programs. The form also includes information about enrollment and HIPPA privacy practices. - Kids Clinic in Avon

Student Enrollment and Registration Form (Spanish)Registration and consent form in Spanish that enrolls a student in the SBHC physical, mental, and oral health programs. The form also includes information about enrollment and HIPPA privacy practices. - Kids Clinic in Avon

Enrollment and Consent Form

Forms in English and Spanish to enroll students into care and authorize parental consent. Includes benefits of SBHCs, hours, cost of services, and enrollment information. - Kids First Health Care

Enrollment Form

A sample enrollment form to enroll new patients in their SBHCs. The sample includes information for patient information, other family members in the household, child's medical history, health care insurance, emergency contact, and insurance payment authorization and release. - Metro Community Provider Network

Registration and Consent Form
Registration and consent forms that collect patient information, family contacts, insurance information, and emergency contact. The tool also includes a statement of HIPAA privacy practices. - Kids' Clinic at Crawford and Laredo

FACILITIES

Sample Equipment, Furniture and Supply List
Excel document that displays equipment and supplies often needed in a SBHC program. Estimates of costs and quantities are also included. - Tulane Section of Adolescent Medicine 

SBHC Floor Plan (4 Exam Rooms)

Sample floor plan that includes four exam rooms, lab, intake/office, a multipurpose room, waiting area, and bathroom. The sample floor plan includes sample furniture or supplies in for each room, along with dimensions of each room. - Aurora Public Schools

SBHC Floor Plans (Various Sizes)

Mock-up of floor plans of various SBHC configurations. The floor plans also include a more detailed construction plan. - Denver Health and Hospital

SBHC Floor Plans (2 Exam Rooms)

Floor plan that a new program can review and use when creating a new SBHC. - Kids Clinic in Avon

JOB DESCRIPTIONS

SBHC Planning Coordinator Job Description

Sample job description for a SBHC planning coordinator that includes a position summary, primary responsibilities, and desired skills, knowledge, and abilities. SBHC programs can use this sample to develop their own job description for a planning coordinator position.

Overview of SBHC Jobs and Roles

A summary of each staff members' job tasks detailing the roles and responsibilities of each team member, individually and as a member of the clinic team. - Kids Clinic in Avon

Clinic Manager Job Description

Job description for a clinic manager position that includes who the position supervises, a job summary, responsibilities, qualifications, and physical requirements.

Director of Practice Management Job Description 

A sample job for a director of practice management that includes who the position reports to, who the position supervises, a job summary, responsibilities, qualifications, and physical requirements.

Administrative Assistant Job Description

Administrative assistant job description includes an overall statement of responsibility, essential duties and responsibilities, minimum qualifications, preferred qualifications, personal characteristics, physical demands, and working environment, among others.

Medical Director Job Description

A sample job description for a medical director that includes a statement of responsibility, outlines specific responsibilities, who the position reports to, who the position supervises, the classification of the position, and skills, values, and talents.

Family Nurse Practitioner Job Description

Job description for family nurse practitioner at a SBHC. The sample includes salary information, available positions, and descriptions of the job that new SBHC programs can guide in developing their own job description for a family nurse practitioner. - Kids Care Clinic in Avon

Pediatric Nurse Practitioner Job Description

A sample job description for a pediatric nurse practitioner that new SBHC programs can adapt when creating their own job descriptions. Components of the job description include title of job, overall statement of responsibility, responsibilities, who the position reports to, who the position supervises, the job classification, and skills, values, and talents desired.

Nurse Practitioner Contract

A contract and memorandum of understanding for a family nurse practitioner at a SBHC. The sample tool includes terms of employment, termination, performance evaluation, leave policies, and other topics for a family nurse practitioner. - Kids Care Clinic in Avon

Role of RN/LPN/Nursing Assistant

This document defines the role of RN/LPN/Nursing Assistant. It is useful when working with a LPN or Nursing Assistant to understand their Scope of Practice.

SBHC Social Worker

A sample job description for a social worker in a SBHC. The sample includes qualifications, job goals, and performance responsibilities. New SBHCs can use this sample to develop a job description for a social worker.

SBHC Medical Receptionist

A sample job description for a medical receptionist at a SBHC that includes a summary, essential duties and responsibilities, qualifications, and others. New SBHCs can use this tool as a guide to develop their own sample job description for a medical receptionist. - Kids Care Clinic in Avon

SBHC Medical Assistant

A sample job description for a medical assistant that includes a summary of the position, job duties, and qualifications, education, and experience required. New SBHC programs can use this sample to develop a job description for a medical assistant. - Kids Care Clinic in Avon

MARKETING

Marketing Strategy Tips

SBHC marketing and communications technical assistance presentation highlighting supported provided to five SBHCs in 2013. Includes SBHC marketing examples and lessons learned. - Bawmann Group

Marketing Plan

A marketing plan developed to increase enrollment and service utilization, convey the value of affordable healthcare in the region, and improve relationships and support for clinic's sustainability. The plan also includes a detailed market analysis with strategies to grow utilization in the community. - Kids Care Clinic in Avon

SBHC Website

User-friendly website detailing information about the SBHC sites. - Kids First Health Care

SBHC Flyers- Various Audiences (English/Spanish)

Flyers advertising SBHC sites and the services available to students. The flyer also lists the different sites and provides information in Spanish as well. - Denver Health and Hospital

Tri-fold Pamphlet

A tri-fold Denver Health and Denver Public Schools advertising SBHCs in Denver with a list of their sites, program partners, services provided and not provided, parental involvement, confidentiality, and costs of services. New SBHCs can adapt this tri-fold to advertise their program in a new community. - Denver Health and Hospital and Denver Public Schools

Flyers for Parents (English/Spanish)

A two page information flyer in both English and Spanish. The flyer shows the types of services offered at a SBHC and provides insurance information for parents. - Kids First Health Care

Enrollment Flyer (English/Spanish)

A marketing flyer developed and used to advertise SBHC sites and adolescent health care services provided. The flyer is in English and Spanish. - Kids First Health Care

Detailed Informational Flyer (English and Spanish)
An informational flyer about the SBHC Kids First Health Care in English and Spanish. Information includes clinic locations, services, the benefits of using an SBHC, hours of operation, cost of services, and the impact on student academic achievement. - Kids First Health Care

SBHC Annual Report
A visualization an annual report detailing its school-based health center network of sites. - Denver Health and Hospital

MINOR CONSENT/CONFIDENTIALITY

Parental HIPAA Form

A sample notice of privacy practices in English and Spanish. The tool provides HIPAA-related information to parents about their rights, choices, how Denver Health uses and discloses information, and other relevant HIPAA information. - Denver Health and Hospital

HIPAA Consent Form

A sample consent form to use confidential information Metro Community Provider Network in compliance with HIPAA. The consent form reviews HIPAA privacy rules for MCPN patients which new SBHCs can adapt. - Metro Community Provider Network

Bill of Patient's Rights and Responsibilities

A sample bill of rights from MPCN outlining the rights patients have at MPCN and the responsibilities as a patient at MCPN.

HIPAA Notice (English)

A sample notice of privacy practices Kids First Health Care that is in compliance with HIPAA. The notice of privacy practice includes understanding health information, how Kids First Health Care may use and disclose health information, other uses and disclosures allowed and/or required by law, and other topics to ensure compliance with HIPAA. - Kids First Health Care

HIPAA Notice (Spanish)
A sample notice of privacy practices Kids First Health that is in compliance with HIPAA in Spanish. The notice of privacy practices includes the same sections as in the English version. - Kids First Health Care

FINANCE & BUDGET

Budget Templates

A sample budget template with tabs for data input, staffing, other costs, in-kind, income statement, and instructions. New SBHCs can use this sample budget template when developing a budget for a new SBHC program. - The Colorado Health Foundation

Enrollment Fee Form (English/Spanish)

An enrollment fee form that families are required to complete and pay when they enroll their child(ren) in the SBHC. The enrollment fee is determined by family size and income. The sample form is in English and in Spanish. - Kids First Health Care

Sliding Fee Scale

Sliding fee scale from 100% of the Federal Poverty Level (FPL) through 300% FPL and above. - Crawford and Laredo Elementary Kids Clinics

Sliding Fee Scale

Sliding fee scale that displays twelve fee codes by different poverty levels, along with a 2015 - 2016 enrollment fee that is required of all families except for all Medicaid patients. - Kids First Health Care

EVALUATION TOOLS

Student Satisfaction Survey

A sample student survey to assess satisfaction of services provided by the SBHCs. - Southwest Open School

Patient Satisfaction Survey (English and Spanish)

A patient satisfaction survey in English and Spanish that asks patients to rate the ease of getting care, waiting, the clinic staff, financial screeners, cost and the facility. - Kids First Health Care

Parent Satisfaction Survey - Southwest Open School

A parent satisfaction survey to ensure parental input for health care services provided at the SBHC. - Southwest Open School

Student Survey

A sample student survey for school students to gauge their knowledge about a SBHC and the services they offer. - Kids First Health Care

Quality Measurement and Improvement Tool

Quality Improvement: Practical Solutions for Improving Patient Care: Online guide outline a five-step quality improvement process to improve patient care.

Starting a SBHC