The CHC-SEK Community Health clinic is scheduled to be at Southeast Junior High School on Monday March 13, 2017 from 8:30 a.m. to 9:45 a.m., then at Southeast High School that same day from 10:00 a.m. to 12:00 p.m.

There is no out of pocket expense but insurance/Medicaid will be billed if applicable. CHC will be providing immunizations, including the influenza vaccine, Meningitis, Hepatitis A, HPV and the Tdap vaccine. (CORRECTION: Since our original post we’ve learned that physicals will NOT be available during this visit due to a scheduling conflict.)

To use this opportunity, please make sure your student brings the following…

Provide copies of insurance/Medicaid cards if available

Patients will need a copy of all insurance cards and/or Medicaid cards, front and back. Again, while there is no out of pocket expense for parents, insurance will be billed when available.

Complete necessary form

The Demographic and consent forms are

Please download and print the following as necessary:

  • ALL students seen must have a completed Demographic form.
  • ALL students seen must have a completed Consent For Treatment form.
  • Any student student getting a flu vaccine must also have a completed flu consent form.
  • Any student getting any other vaccine must also have a completed goldenrod form. The goldenrod form is not necessary if ONLY getting the flu vaccine.
  • (Keep for future use) Any student getting a sports physical must also have a sports physical form completed and signed by a parent. If there are any “Yes” answers on the front page, please provide an explanation at the bottom of the page.
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