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Official Website

of the Commonwealth of Pennsylvania

    The .gov means its official.

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    These tally sheets were designed to assist schools in gathering the information required for the "School Health Annual Request for Reimbursement" report. They should NOT be submitted to the Division of School Health. 

    Tally sheets are provided for the collection of daily and monthly data, in two formats:

         1. Electronic- Data may be entered directly onto the tally sheets via the computer. They have been designed in an Excel format and are "functional" meaning that they will automatically calculate the data as it is entered. Before entering data, save this file to your computer by using the "Save as" function (Click on File, then Save As). Only cells requiring data input are accessible. The other cells are locked.

         2. Manual- These tally sheets may be printed and used in hard-copy format.

    Average Daily Membership (ADM) - Private and non-public schools receiving school health services from school districts are to report their ADM numbers, to the school district, at the end of each school year for submission in the annual school health report.

    1. Average Daily Membership (ADM) - Manual
    2. Average Daily Membership (ADM) - Electronic

    Dental Program (Mandated and Dental Hygiene)

    1. Mandated Dental Program - Daily/Monthly - Electronic
    2. Mandated Dental Program - Daily/Monthly - Manual
    1. Dental Hygiene Services Program - Monthly - Electronic
    2. Dental Hygiene Services Program - Monthly - Manual
    1. Fluoride Program - Monthly - Electronic
    2. Fluoride Program - Monthly - Manual

    Mandated Health Screens

    1. Health Screens - Daily - Electronic
    2. Health Screens - Daily - Manual
    3. Health Screens - Daily/Monthly - Electronic
    4. Health Screens - Daily/Monthly - Manual

    Health Services

    1. Health Services - Daily/Monthly - Electronic
    2. Health Services - Daily/Monthly - Manual

    Medication Administration

    1. Medication Administration - Daily - Electronic
    2. Medication Administration - Daily - Manual
    3. Medication Administration - Monthly - Electronic
    4. Medication Administration - Monthly - Manual

    Physical Examinations

    1. Physical Examinations - Daily/Monthly - Electronic 
    2. Physical Examinations - Daily/Monthly - Manual

    Serious School Injury

    1. Serious School Injury - Daily/Monthly - Electronic
    2. Serious School Injury - Daily/Monthly - Manual

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