Custom Reports: Emergency Verification Form

Modified on Fri, Jun 9, 2023 at 2:48 PM

The attached ReportWriter report produces an Emergency Information Verification Form:

The form lists contact information, as well as some medical and insurance information and is "custody sensitive":  it provides options to exclude Guardian 1 information to appear on the "Guardian 2" copies of the form and to exclude "Guardian 2" information from "Guardian 1" versions of the form.

The form displays information for:

- Guardians 1 - This can be suppressed if the form is to be filled out by "Guardian 2" (when Guardian 2 is an out-of-legal-residence parent).

- Guardian 2 - This can be suppressed if Guardian 2 is out of house and there is a custody issue flagged on the student's record.

- Emergency Contacts 1, 2 & 3:  Information is shown for up to 3 emergency contacts.  Please be aware that there are no built-in limits on how many Emergency Contacts a student can have.   That is:  there can be more Emergency Contacts defined for a student than can appear on this form.

- Doctor, Dentist and Hospital Information - Names and phone numbers for a doctor, a dentist and a hospital will be shown on the form if contacts with those Relationships exist on the student's record.  Again, there are no built-in limits on these types of contacts.  More doctors can be listed on a student's "Contacts" screen than can be included on this form.

- Medical Information:  some medical information is included on the form:

   - A list of the medical conditions currently flagged on the student's medical record.

   - Specific question asking if the student carries an EPIPEN.    (Condition Code of EPI)

   - Specific question regarding whether a student wears glasses or contact lenses.  (Condition codes WEARS_GLASSES or WEARS_CONTACTS)

   - Specific question if the student suffer from asthma.   (Condition Code of AST)

This report will need to be customized - really 'localized' - to work with your district's information.  Specifically, to determine custody issues, the report only looks at the "Guardian 1" and "Guardian 2" contacts for a student.  It does not examine Guardian 3 or Guardian 4.   As such, it is assuming that if there is a custody issue and an "out of house (biological) parent" that parent will be Guardian 2.   If your district codes out of house biological parents as Guardian 3, this report will have to be altered to work that way.

The condition codes (EPI, AST, WEARS_GLASSES, WEARS_CONTACTS) for the medical questions must be in use in your district, or you will need to customize the report to use your local medical condition codes for these.

Download Report

Custom Reports: Emergency Verification Form (Spanish)

A Spanish version of Contact Emergency Verification Form. You can replace the form with your own custom Spanish form. 

Download Report  Download Template

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