Joint Circular No. 13/2016/TTLT-BYT-BGDDT dated May 12, 2016 of the Ministry of Health and the Ministry of Education and Training on regulations on healthcare activities in schools

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Issuing body:	Ministry of Education and Training; Ministry of Health	Effective date:	Known Please log in to a subscriber account to use this function. Don’t have an account? Register here
Official number:	13/2016/TTLT-BYT-BGDDT	Signer:	Nguyen Thi Nghia; Nguyen Thanh Long
Type:	Joint Circular	Expiry date:	Updating
Issuing date:	12/05/2016	Effect status:	Known Please log in to a subscriber account to use this function. Don’t have an account? Register here
Fields:	Medical - Health

SUMMARY

Notify students’ parents or guardians of their child’s health periodically

At the Joint Circular No. 13/2016/TTLT-BYT-BGDDT dated May 12, 2016 on regulations on healthcare activities in schools, notify students’ parents or guardians of their child’s health at least once an academic year or where necessary. Medical staff shall assess students’ health status by the graduation as the basis for health recording in the higher level.

At the same time, carry out health examination at the beginning of every academic year to assess student’s physical and nutritional status by measuring the height and weight of students of under 36 months olds; and measuring the height and weight, blood pressure, heart rate and visual acuity of students of older 36 months old . Monthly and quarterly measure the height and weight and record physical developmental milestone charts of under-24- month students and above-24-month students, respectively; measure BMI at least twice an academic year to provide advices on nutrition and physical exercises for high school students. Regularly examine student’s health, visual acuity, curvature of spine, oral diseases, metal health and other diseases to cure….

Beside school health management and education , schools also must ensure the requirements for water supply and drainage and environmental hygiene in schools, every school shall supply sufficient drinking water in a quantity of at least 0.5 liter per student/class in summer and 0.3 liter per student/class in winter; every school supply sufficient domestic water in a quantity of at least 5 liters per student/class. If the domestic water is distributed through pipelines, each nozzle shall be designed to meet the need of not exceeding 200 students per class…

This Circular takes effect on June 30, 2016.

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Effect status: Known

THE MINISTRY OF HEALTH - MINISTRY OF EDUCATION AND TRAINING

Joint Circular No.13/2016/TTLT-BYT-BGDDT dated May 12, 2016 of the Ministry of Health and the Ministry of Education and Training on regulations on healthcare activities in schools

Pursuant to the Government’s Decree No.63/2012/ND-CP on functions, entitlement, responsibilities and organizational structures of Ministry of Health dated August 31, 2012;

Pursuant to the Government’s Decree No.32/2008/ND-CP on functions, entitlement, responsibilities and organizational structures of the Ministry of Education and Training dated March 19, 2008;

Pursuant to the Directive No.23/2006/CT-TTg on healthcare in educational institutions dated July 12, 2006 by the Prime Minister;

The Minister of health and Minister of Education and Training hereby issues this Joint Circular stipulating regulations on healthcare activities in schools.

Chapter I

GENERAL PROVISIONS

Article 1. Scope of adjustment and subject of application

1.This Joint Circular stipulates regulations on healthcare activities in schools in respects of facilities, equipment, environment and other healthcare services for students.

2.This Joint Circular applies to preschool education institutions, primary schools, lower secondary schools, upper secondary school, combined schools, specialty schools excluding reform schools or schools for the disabled (hereinafter referred to as “school”) and relevant entities.

Article 2. Interpretation of terms

For the purposes of this Joint Circular, terms herein shall be construed as follows:

1.School hygiene refers to conditions of the study environment, facilities in schools and classrooms, teaching tools, hygienic conditions for teaching, studying, physical practice and healthcare.

2.Compulsory schooling disease refers to a disease that student mat suffer from due to poor hygienic conditions in schools.

Article 3. Sources of financing for healthcare activities in schools

1.Healthcare activities in schools are financed from:

a) Annual funding for health and education allocated according the current budget of the organization;

b) Funding from student health insurances under current regulations of laws;

c) Funding from domestic and overseas entities and other legal earnings under regulations of laws.

2.The funding for healthcare activities in schools shall be properly allocated in accordance with the State’s current regulations of laws.

3.The estimation, allocation and finalization of such funding shall be made in accordance with current regulations of laws.

Chapter II

REQUIREMENTS FOR HEALTHCARE ACTIVITIES IN SCHOOLS

Article 4. Requirements for classrooms, student desks, chalkboards, lighting systems and toys in schools

1.Classrooms

a) For preschool education institutions:

Every classroom of preschool education institutions (hereinafter referred to as “preschool”) shall satisfy the design requirements stipulated in item 5.2 of the Vietnam Standards 3907: 2011( hereinafter referred to as “TCVN” ) issued together with the Decision No.2585/QD-BKHCN on publishing national standards dated August 23, 2011 by the Minister of Science and Technology (hereinafter referred to as Decision No.2585/QD-BKHCN);

b) For primary schools, primary classrooms in combined schools and specialty schools:

Every classroom in above-mentioned schools shall satisfy the design requirements stipulated in item 5.2 of TCVN 8793: 2011 issued together with the Decision No.2585/QD-BKHCN;

c) For lower secondary schools; upper secondary school; and classrooms for upper and lower high school students in combined schools and specialty schools:

Every classroom of above-mentioned school shall satisfy the designed requirements stipulated in item 5.2 of TCVN 8794: 2011 issued together with the Decision No.2585/QD-BKHCN.

2.Student desks and chairs

a) For preschool education institutions:

The dimension of student desks shall conform to TCVN 1993: Desks and chairs for preschoolers – general requirements;

b) For primary schools, lower secondary schools; upper secondary school, combined schools and specialty schools:

The dimension of student desks and chairs shall conform to the Joint Circular No.26/2011/TTLT-BGDDT-BKHCN-BYT on guidelines for standards of student desks and chairs in primary schools, lower secondary schools and upper secondary school.

3.Chalkboards in high schools

a) Every classroom shall have anti-glare chalkboards; dark green boards or blackboards (if white chalks are used) or whiteboards (if markers are used);

b) Every chalkboard shall be 1.2 – 1.5 m in width and 2.0 – 3.2 m in length;

c) Every chalkboard shall be put up in the middle of the wall, the distance from lower edge of the chalkboard to the classroom floor shall be 0.8 – 1.0m (for lower secondary schools and upper secondary school) and the distance from the chalkboard to the first-row desk shall be at least 1.8 m.

4.Lighting systems

For preschools:

The lighting system shall be designed in conformity with the TCVN 3907:2011 issued together with the Decision No.2585/QD-BKHCN;

b) For primary schools, primary classrooms in combined schools and specialty schools:

The lighting system shall be designed in conformity with requirements in item 6.2 of the TCVN 8793: 2011 issued together with the Decision No.2585/QD-BKHCN;

c) For lower secondary schools; high schools; classrooms for junior or senior high school students in combined schools and specialty schools:

The lighting system shall be designed in conformity with requirements in item 6.2 of TCVN 8794: 2011 issued together with the Decision No.2585/QD-BKHCN.

5.Preschool toys

Every preschool toy shall be conformable to the Circular No.16/2011/TT-BGDDT on provision, management and utilization of preschool toys dated April 13, 2011 by the Minister of Education and Training.

Article 5. Requirements for water supply and drainage and environmental hygiene in schools

1.Drinking water and domestic water supply

a) Every school shall supply sufficient drinking water in a quantity of at least 0.5 liter per student/class in summer and 0.3 liter per student/class in winter;

b) Every school supply sufficient domestic water in a quantity of at least 5 liters per student/class. If the domestic water is distributed through pipelines, each nozzle shall be designed to meet the need of not exceeding 200 students per class;

c) Every boarding school shall supply sufficient drinking water and domestic water in the minimum quantity of 100 liters per student per 24 hours;

d) The water shall be bought from facilities that are eligible to supply domestic and drinking water. In case of self-sufficiency of drinking water, the quality of drinking water shall satisfy national technical regulations (QCVN 6 -1:2010/BYT) dated June 17, 2009 by the Minister of Health on drinking water quality; the quality of mineral water and bottled water shall satisfy the QCVN 6 -1:2010/BYT issued together with the Circular No.34/2010/TT-BYT dated June 02, 2010 by the Minister of Health on introduction of national technical regulations on mineral water and bottled water; and the quality of domestic water shall satisfy the QCVN 02:2009/BYT issued together with the Circular No.05/2009/TT-BYT on introduction of national technical regulations on domestic water quality dated June 17, 2009 by the Minister of Health.

2.Sanitation infrastructures

a) With respect of design:

-a)For preschools:

Every sanitation infrastructure shall be designed in conformity with standards stipulated in item 5.2.7. and 5.5.8 of TCVN 3907:2011 issued together with the Decision No.2585/QD-BKHCN ;

-b) For primary schools, primary classrooms in combined schools and specialty schools:

Every sanitation infrastructure shall be designed in conformity with standards stipulated in items 5.6.1 and 5.6.2 and 5.6.3 of TCVN 8793:2011 issued together with the Decision No.2585/QD-BKHCN;;

-c) For lower secondary schools; upper secondary school; classrooms for junior or senior high school students in combined schools and specialty schools:

Every sanitation infrastructure shall be designed in conformity with standards stipulated in item 5.6 of TCVN 8794:2011 issued together with the Decision No.2585/QD-BKHCN.

b) With respect of hygienic conditions of latrines:

Every latrines shall conform to the QCVN 01:2011/BYT issued together with the Circular No.27/2011/TT-BYT on issue of national technical regulations on latrines –hygienic conditions dated June 24, 2011 by the Minister of Health.

c) Every hand wash area shall be provided with clean water, soap or antiseptics.

3.Waste collection and treatment

a) Every school shall have combined drainage systems, and separate drainage systems in laboratories, practice rooms, first aid rooms, restrooms and animal raising areas.

b) Every school shall cooperate with qualified facilities to collect and treat wastes. In case that the school wishes to collect and treat wastes on their own, the collection and treatment shall be carried out in accordance with clause 4, section VII, part II of QCVN 07:2010/BYT- sanitation and hygiene for prevention of infectious diseases in national education system issued together with the Circular No.46/2010/TT-BYT dated December19, 2010 by the Minister of Health on issue of the national technical regulations on sanitation and hygiene for prevention of infectious diseases in national education system (hereinafter referred to as “Circular No.46/2010/TT-BYT ).

Article 6. Requirements for food safety

1.For schools with canteens for boarding students or semi-boarding students

a)The canteen shall have its facilities met all requirements for food safety prescribed clauses 1, 2 and 3, Section VI and hygiene requirements for food processing and storage promulgated in clause 5 of the QCVN 07:2010/BYT-prevention and control of infectious diseases in schools within the national education system issued together with the Circular No.46/2010/TT-BYT;

b) Every canteen in schools shall meet requirements stipulated in Article 4 of the Circular No.30/2012/TT-BYT on food safety and hygiene for food and beverage services and street vendors dated December 05, 2012 by the Minister of Health.

c) Every canteen staff shall meet health conditions prescribed in the Circular No. 15/2012/TT-BYT dated September 12th 2012 of the Ministry of Health on the general conditions for food safety applicable to establishments that produce and trade food.

2.For schools without canteens for boarding students or semi-boarding students entering into contracts with others that is certified satisfactory for food safety to provide meals for students; the canteen shall satisfy requirements in point b, clause 1 of this Article.

Article 7. Execution of school health policies and development of social relationships between schools and community

1.The Student Health Advisory Committee shall clarify member’s responsibilities and hold meetings at least once a semester.

2.Comply with policies and regulations on healthcare in schools.

3.Deepen relationships between teachers and students, and between students , create healthy study environment without discrimination and violence.

4.Create school-parent and school – community relationships to facilitate school healthcare.

Article 8. Requirements for school’s first aid rooms and medical staff

1.For first aid rooms

a) Every school shall have their own first aid room that is situated in a convenient location and covers a required standard areas to facilitate the school health services.

b) Every first aid rooms of primary schools, lower secondary schools, upper secondary school, combined schools and specialty schools shall be equipped with at least 01 sickbed, working desk, chair, cabinet, scale, ruler, sphygmomanometer, thermometer, eye chart, splint and essential drugs for first aid and emergency administration and student healthcare under the Decision No.1221/QD-BYT on lists of essential drugs and equipment used for first at rooms of primary schools, lower secondary schools, upper secondary schools and combined schools dated April 07, 2008 by the Minister of Health. Every preschool shall be provided with specialized equipment and essential drugs according to students’ ages;

c) Every first aid room shall have health examination records using the form A1/YTCS prescribed in the Circular No.27/2014/TT-BYT on medical reporting forms for medical facilities of provinces, districts and communes, health records for students using the form 01 and integrated health record using the form 02 in the Appendix 01 herewith.

2.For school’s medical staff

a) Every medical staff shall acquire at least an associate degree in physician assistant. According to the reality, every school shall hire medical staff who meet the qualifications requirement or sign contract for school health with general medical stations or medical examination and treatment facilities;

b) Medical staff shall regularly attend health seminars, or training courses held by health and education authorities;

c) Medical staff shall consult school boards about the implementation of Articles 9 and 10 and other tasks assigned by the school board.

Article 9. School health management and education

1.Carry out health examination at the beginning of every academic year to assess student’s physical and nutritional status by measuring the height and weight of students of under 36 months olds; and measuring the height and weight, blood pressure, heart rate and visual acuity of students of older 36 months old .

2.Monthly and quarterly measure the height and weight and record physical developmental milestone charts of under-24- month students and above-24-month students, respectively; measure BMI at least twice an academic year to provide advices on nutrition and physical exercises for high school students.

3.Regularly examine student’s health, visual acuity, curvature of spine, oral diseases, metal health and other diseases to cure and apply a proper learning environment and physical exercises.

4.Cooperate with qualified medical facilities to carry out specialty examination and treatment.

5.Administer first aid and emergency treatment under current regulations of the Minister of Health.

6.Provide students, their parents or guardians and teachers with advice on common diseases, student physical and mental development and healthcare; in case of disabled students, assist them in inclusive education.

7.Provide instructions on healthy meal and diversified foods according to student’s age ( for boarding schools and semi-boarding schools)

8.Cooperate with local medical facility to administer vaccines to students.

9.Notify students’ parents or guardians of their child’s health at least once an academic year or where necessary. Medical staff shall assess students’ health status by the graduation as the basis for health recording in the higher level.

10.Record the student health in health examination record, health record and integrated health record.

11.Regularly inspect and supervise the study environment, school hygiene, food safety, drinking water and hand wash. Implement measures for preventing and controlling diseases under the Circular No.46/2010/TT-BYT and other instructions of medical authorities.

12.Conduct medical programs and hygiene campaign, participate in physical exercises, healthy meal, and create smoke-free, alcohol-free and addictive-free schools.

Article 10.Health education

1.Compile and use documents on health education according to student age and the local reality.

2.Educate students, their parents or guardians about infectious disease and food poisoning prevention measures ; nutrition, physical exercises, cigarette and alcohol effect, compulsory schooling diseases, oral health, eye diseases and other injuries; propagate and participate in health education programs launched by the Ministry of Health and Ministry of Health and Training.

3.Include health education in lectures.

4.Get students participate in personal hygiene, school and environment cleaning, infectious healthy meal, physical exercises, prevention of tobacco and alcohol adverse effects, compulsory schooling diseases, eye diseases and injuries via proper models and methods

Article 11.School health reporting and assessment

1.Periodic and irregular reports

a) Submit annual reports using the form in Appendix 02 herewith to the medical station of the commune, Division of Education and Training and Department of Education and Training by May 10 of every academic year.

b) Submit irregular reports at request of superior authorities.

2.Assessment of healthcare activities in schools

Every school shall carry out self-assessment of school health performance by the end of academic year using the form 03 in the Appendix herewith (for preschool education institutions) or the form in the Appendix 04 herewith (for primary schools; lower secondary schools, high schools, combined schools and specialty schools).

Chapter III

IMPLEMENTATION ORGANIZATIONS

Article 12. Responsibilities of schools

Every school shall:

1.Comply with provisions of healthcare in schools as stipulated in this Circular.

2.Supervise, inspect and provide instructions on the implementation of school health.

3. Provide necessary facilities, equipment and drugs for medical staff to conduct school health services.

4.Request competent authorities to provide medical staff for school healthcare.

5.Set up Student Health Advisory Board in which the school board’s representative plays as the Chief, Head of medical station of commune as Deputy chief, school medical staff as standing members, physical teachers, teacher in charge of Ho Chi Minh Young Pioneer Organization of the school (for primary and lower secondary schools) and representatives of Communist Youth Union of Ho Chi Minh City, school’s red cross and Parent-Teacher Association as members.

6.Consult competent authorities about current regulations and standards in case of construction, renovation, purchase of equipment, teaching tools, preschool toys, medical facilities and drugs.

Article 13. Responsibilities of medical stations of communes

Every medical station of communes shall:

1. Include school health plans in the general health plan of the commune.

2. Assign personnel to supervise the school health and support school’s medical staff in medical profession to fulfill responsibilities stipulated in this Circular.

3. Submit statistics and reports on school health under regulations of laws.

Article 14. Responsibilities of Divisions and Departments of Education and Training

Every Division and Department of Education and Training shall:

1. Cooperate with health authorities of communes andPeople’s Committees at all levels to draw up school health plans and execute such plans within their jurisdiction.

2. Expedite, supervise and inspect school health implementation under this Joint Circular.

3. Cooperate with health authorities to provide school’s medical staff with training courses in school health.

4. Cooperate with local authorities to carry out annual assessment of health school within their jurisdiction.

5. Submit statistics and reports on school health under regulations of laws.

6. Have school’s medical staff recruited in accordance with regulations of competent authorities.

7. Consult competent authorities about current regulations and standards in case of construction, renovation, purchase of equipment, teaching tools, preschool toys, medical facilities and drugs.

Article 15. Responsibilities of medical centers of districts and preventive medical centers of provinces and Departments of Health

Every medical center of districts and preventive medical center of provinces and Department of Health shall:

1. Take charge of and cooperate with education authorities to assist People’s Committees at all levels in preparation of school health plans and provision of instruction on plan execution within their jurisdiction.

2. Cooperate with education authorities to provide school’s medical staff with training courses in school health and instructions on management, propagation and education of healthcare.

3. Inspect and supervise the school and environmental hygiene, student health education and other relevant aspects.

4. Submit school health statistics and reports under regulations of laws.

Article 16. Responsibilities of affiliates of the Ministry of Health and Ministry of Education and Training

1. The General Department of Preventive Medicines the focal authority of the Ministry of Health; and student Affairs as the focal authority of the Ministry of Education and Training shall take charge of executing provisions hereof.

2. Every affiliates of the Ministry of Education and Training, and Ministry of Health shall prepare school health plans, execute such plans and report the achievements and limitations according to the jurisdiction.

Article 17. Responsibilities of People’s Committees at all levels

Every People’s Committee shall:

1. Approve annul school health plans prepared by schools within their administration, proactively provide schools with funding, personnel and faculties for healthcare.

2. Establish Steering Committees of school health in which the Head of the People’s Committee plays as the Chief, Head of education authorizes and health authority play as deputy chiefs, heads of departments of finance, department of homer affairs, department of investment and planning, departments of social insurances, preventive medical centers of provinces and destructs and relevant agencies play as members; or assign People’s Healthcare Committee of the same level to take charge of school health, and define functions and responsibilities of each members.

3. Mobilize resources to upgrade facilities and school environment, study conditions and health conditions within their administration under regulations of laws.

4. Direct regulatory authorities to participate in school health services within the administration.

5. Approve and provide instructions on planning, renovation and purchase of equipment, teaching tools, medical facilities according to current regulations and standards.

6. Introduce preferential policies on school s medical staff.

Chapter IV

IMPLEMENTATION PROVISIONS

Article 18. Reference provisions

In the event that legislative documents referred to this Joint Circular is amended or replaced, the new ones shall prevail.

Article 19. Effect

1. This Circular takes effect on June 30, 2016.

2. As its effective date, this Joint Circular replaces Article 4 of the regulation of healthcare in preschool education institutions issued together with the Decision No.58/2008/QD-BGDDT dated October 17, 2008 by the Minister of Education and Training; Article 4 of the regulation in healthcare in primary schools, lower secondary schools, high schools and combined schools issued together with the Decision No.73/2007/QD-BGDDT dated December 04, 2007 by the Minister of Education and Training; Decision No.1221/2000/QD-BYT dated April 28, 2000 by the Minister of Health; Joint Circular No.18/2011/TTLT-BGDDT-BYT on assessment of healthcare in primary school, lower secondary schools, high schools and combined schools dated April 18, 2011 by the Minister of Education and Training and Minister of Health; Joint Circular No.22/2013/TTLT-BGDDT-BYT on assessment of healthcare in preschool education institutions dated June 18, 2013 by the Minister of Education and Training and Minister of Health, and relevant provisions of assessment of healthcare in preschools, lower secondary schools and high schools prescribed in the Joint Circular No.03/2000/TTLT-BYT-BGDDT dated March 01, 2000 by the Minister of Education and Training and Minister of Health.

Article 20. Transitional provisions

Every operating school shall have satisfied requirements for planning, design and construction according current standards and regulations by January 01, 2020.

Any issue arising from the implementation of this Circular should be reported to the Student Affairs – Ministry of Education and Training and General Department of Preventive Medicine- Ministry of Health./.

For the Minister of Education and Training

The Deputy Minister

Nguyen Thi Nghia

For the Minister of Health

The Deputy Minister

Nguyen Thanh Long

LIST OF APPENDIXES

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 22, 2016 by the Minister of Education and Training and Minister of Health)

Appendix 01. Forms for health records and integrated health records

Form 01. Health record

The health record is made in A5 size (14.8cm x 21cm). The school shall select one of the following health record forms according to student age:

-Health record for students from 03 months to under 06 years old

-Health record for students from first grade to fifth grade.

-Health record for students from sixth grade to ninth grade.

-Health record for students from tenth grade to twelfth grade.

Form 02. integrated health record

Appendix 02. School health report form

Appendix 03.Assessment of healthcare activities in schools (for preschool education institutions)

Appendix 04.Assessment of healthcare activities in schools (for high schools)

Made in A5 (14.8cm x 21cm)

APPENDIX 01

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 12, 2016 by the Minster of Education and Training)

The front cover

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

HEALTH RECORD

Full name(uppercase)…………..………... Male □ Female □

Date of birth:………………………………………

School name:……………………………………...……………….

District: ………………….……………….

Province:………………….……………….

For preschoolers
(From 03 months to under 6 years old)

(This record shall be kept during the preschool age, in case of school transfer, the student shall submit this record to the new school)

The back cover

PART I – GENERAL INFORMATION

(To be completed by student’s parents )

1. Student full name(upper case):………….……………………….. Male □ Female □

2. Date of birth:………………………………………

3. Full name of father/guardian :.....................................................................................

Occupation...................................................................... Contact number.....................

Current residential address:.......................................................................................

4. Full name of mother/guardian:...................................................................................

Occupation............................................................................... Contact number............

Current residential address:.......................................................................................

5. Birth order:…………………………….. Total number of children::………………………

6. Health history:..................................................................................................

Obstetrics

-Normal □

-Abnormal: Preterm birth □ Post mature birth □ Medical interventions during labor □ Prenatal asphyxia □

-Diseases in pregnancy (specify): ..............................................

..........................................................................................................................................

b) History of diseases: Asthma □ epilepsy □ Allergy □ Congenital heart diseases □

c)Immunization

No.	Vaccines	Vaccination
No.	Vaccines	Yes	No	Not sure
1	BCG
2	Diphtheria, peruses and tetanus
	First dose
	Second dose
	Third dose
3	Polio vaccine
	First dose
	Second dose
	Third dose
4	Hepatitis B
	Infants
	First dose
	Second dose
	Third dose
5	Measles
6	Japanese Encephalitis B
	First dose
	Second dose
	Third dose
7	…..

d)Ifinany treatment or on any medication, please statediseases and drug name:

...........................................................................................................................................

7. Changes in residential address or contact number (if any)...........................................

..........................................................................................................................................

SCHOOL NAME:..............................................................................................................

FULLNAME OF STUDENT...............................................................................................

(For under-24 – month students)

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

1.Physical examination(once every month)

CLASS……………………………………..ACADEMIC YEAR……………………………………..

Date.............

Examining doctor
(signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examiningdoctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examiningdoctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Date.............

Examining doctor
(Signature and full name)

Height:………m;

Weight:………kg;

Nutrition:

-Well-nourished □

- Malnuourished □

- Obese □

Nutrition:

-Well -noursihed □

- Malnourished □

- Obese □

SCHOOL NAME:..............................................................................................................

FULLNAME OF STUDENT...............................................................................................

(For students from 24 months to under 26 months old)

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

1.Physical examination( First examination – at the beginning of an academic year, Second examination - at the middle of an academic year, Third examination - At the end of an academic year)

CLASS……………………………………..ACADEMIC YEAR ………………………………

First examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

Second examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

Third examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

SCHOOL NAME:................................................................................................................

FULLNAME OF STUDENT.................................................................................................

(For students from 36 months to under 6 years old)

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

1.Physical examination( First examination – at the beginning of an academic year, Second examination - at the middle of an academic year, Third examination - At the end of an academic year)

CLASS……………………………………..ACADEMIC YEAR ………………………………

First examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

Third examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

CLASS…………………………………….. ACADEMIC YEAR ………………………………

First examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Without glasses: Right eye:……./10 Left eye:……./10

With glasses: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

Third examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

CLASS…………………………………….. ACADEMIC YEAR ………………………………

First examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

Third examination

Examining doctor
(Signature and full name)

Physical status:

- Height:………m;

- Weight:………kg;

Nutritional status:

- Well-nourished □

- Malnourished □

- Obese □

2. Abnormalities

Date	Initial diagnosis	Treatment		Remarks
Date	Initial diagnosis	At school (specify treatments)	Referral to (specify receiving facility)	Remarks
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PART 3 – HEALTH SPECIALTY EXAMINATION

(To be completed by specialty physicians or doctors)

Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Paediatrics a) Cardiovascular …………………………………………………………………. ………………………………………………………………………………….. b) Respiratory: ………………………………………………….……………. ………………………………………………………………………………….. c) Gastrointestinal…………………………………………………………….. d) Renal-urinary ……………………………………………………………. ………………………………………………………………………………….. dd) Neurological - Psychiatric………………………………………………… e) Others………………………………………………………………………
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Eyes a)Vision test: - Unaided: Right eye:……./10 Left eye:……./10 - Aided: Right eye:……./10 Left eye:……./10 b) Eye diseases (if any) ……………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Ear-Nose-Throat a)Hearing test: - Left ear: Conversational voice::…….. m; whispered voice:…….m - Right ear: Conversational voice::…….. m; whispered voice:…….m b) Other related diseases (if any)……………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Oral and maxillofacial system Oral and maxillofacial test -Maxilla…………………………………………………………………….. ………………………………………………………………………………….. -Mandible…………………………………………………………………….. ………………………………………………………………………………….. b) Oral maxillofacial pathology (if any)……………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Musculoskeletal system a)Musculoskeletaltest - Normal □ - Curvature: Kyphosis □ Lordosis □ - Scoliosis: S-line □ C-line □ b) Other musculoskeletal disorders (if any)……………………………… ………………………………………………………………………………….. …………………………………………………………………………………..

Made in A5 (14.8cm x 21cm)

Appendix 01

FORM 01. HEALTH RECORD

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on healthcare in schools dated May 12, 2016 by the Minster of Education and Training)

The front cover

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

HEALTH RECORD

Full name(uppercase)…………..………... Male □ Female □

Date of birth:………………………………………

School name:……………………………………...……………….

District: ………………….……………….

Province:………………….……………….

For students from the first grade to fifth grade

(This record shall be kept during the primary school age, in case of school transfer, the student shall submit this record to the new school)

The back cover

PART I – GENERAL INFORMATION

(To be completed by student’s parents)

1. Full name of student(upper case):……………………………….. Male □ Female □

2. Date of birth:………………………………………

3. Full name of father/guardian :...................................................................................

Occupation................................................ Contact number..........................................

Current residential address:.......................................................................................

4. Full name of mother/guardian :....................................................................................

Occupation................................................ Contact number..........................................

Current residential address:.......................................................................................

5. Birth order:…………………………….. Total number of children::………………………

6. Health history:..................................................................................................

a)Obstetrics:

-Normal □

-Abnormal: Preterm birth □ Post mature birth □ Medical interventions □ Prenatal asphyxia □

-Diseases in pregnancy (specify): ..............................................

.......................................................................................................................................

b) History of diseases: Asthma □ Epilepsy □ Allergy □ Congenital heart diseases □

c) Immunization:

No.	Vaccines	Vaccination
No.	Vaccines	Yes	No	Not sure
1	BCG
2	Diphtheria, pertussis and tetanus
	First dose
	Second dose
	Third dose
3	Polio
	First dose
	Second dose
	Third dose
4	Hepatitis B
	Infants
	First dose
	Second dose
	Third dose
5	Measles
6	Japanese Encephalitis B
	First dose
	Second dose
	Third dose
7	…..

d) If in any treatment or on medication, please state diseases and drug name:

..........................................................................................................................................

7. Changes in residential address or contact number (if any)..........................................

.........................................................................................................................................

SCHOOL NAME:.............................................................................................................

FULLNAME OF STUDENT.............................................................................................

PART II – PHYSICAL EXAMINATION

(To be completed by school’s examining doctors)

1.Examination of appearance, blood pressure, heart rate and vision(first examination – at the beginning of an academic year, Second examination - at the beginning of the second Semester)

FIRST GRADE…………………..ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m2)

SECOND GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m2)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

THIRD GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

FOURTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

FIFTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

2. Abnormalities

Date	Initial diagnosis	Treatment		Remarks
Date	Initial diagnosis	At school (specify treatments)	Referral to (specify receiving facility)	Remarks
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PART 3 – HEALTH SPECIALTY EXAMINATION

(To be completed by specialty physicians or doctors)

Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Paediatrics a) Cardiovascular …………………………………………………………………. ………………………………………………………………………………….. b) Respiratory: ………………………………………………….…………………. ………………………………………………………………………………….. c) Gastrointestinal…………………………………………………..………… ………………………………………………………………………………….. d) Renal-urinary ……………………………………………………………. ………………………………………………………………………………….. dd) Neurologic - Psychiatric……………………………………………………… ………………………………………………………………………………….. e) Others…………………………………………………………………………
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Eyes a)Vision test: - Unaided: Right eye:……./10 Left eye:……./10 - Aided: Right eye:……./10 Left eye:……./10 b) Eye diseases (if any) ……………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Ear-Nose-Throat a)Hearing test: - Left ear: Conversational voice::…….. m; whispered voice:…….m - Right ear: Conversational voice::…….. m; whispered voice:…….m b) Other related diseases (if any)…………………………………………… ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Oral and maxillofacial system a)Oral and maxillofacial examination: -Maxilla…………………………………………………………………….. ………………………………………………………………………………….. -Mandible…………………………………………………………………….. ………………………………………………………………………………….. b) Oral maxillofacial pathology (if any)…………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Musculoskeletal system a)Musculoskeletal test - Normal □ - Curvature: Kyphosis □ Lordosis □ - Scoliosis Scoliosis: S-shaped □ C-shaped □ b) Other musculoskeletal disorders (if any)……………………………… ………………………………………………………………………………….. …………………………………………………………………………………..

Made in A5 (14.8cm x 21cm)

Appendix 01

FORM 01. HEALTH RECORD

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 12, 2016 by the Minister of Education and Training)

The front cover

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

HEALTH RECORD

Full name(uppercase)…………..………... Male □ Female □

Date of birth:………………………………………

School name:……………………………………...……………….

District: ………………….……………….

Province:………………….……………….

For students from sixth grade to ninth grade

(This record shall be kept during the junior school age, in case of school transfer, the student shall submit this record to the new school)

The back cover

PART I – GENERAL INFORMATION

(To be completed by student’s parents)

1. Full name of student(upper case):…………………………….. Male □ Female □

2. Date of birth:………………………………………

3. Full name of student’s father/guardian :....................................................................

Occupation................................................ Contact number..........................................

Current residential address:.......................................................................................

4. Full name of student’s mother/guardian :..................................................................

Occupation................................................ Contact number..........................................

Current residential address:.......................................................................................

5. Birth order:…………………………….. Total number of children::……………………

6. Health history:..................................................................................................

a)Obstetrics:

-Normal □

-Abnormal: Preterm birth □ Postmature birth □ Medical interventions during labour □ Prenatal asphyxia □

-Diseases in pregnancy (specify): ..............................................

..........................................................................................................................................

b) History of diseases: Asthma □ Epilepsy □ Allergy □ Congenital heart diseases □

c) Immunization:

No.	Vaccines	Vaccination
No.	Vaccines	Yes	No	Not sure
1	BCG
2	Diphtheria, pertussis and tetanus
	First dose
	Second dose
	Third dose
3	Polio
	First dose
	Second dose
	Third dose
4	Hepatitis B
	Infants
	First dose
	Second dose
	Third dose
5	Measles
6	Japanese Encephalitis B
	First dose
	Second dose
	Third dose
7	…..

d) If under any treatment or on medication, please state diseases and drug name:

.........................................................................................................................................

7. Changes in residential address or contact number (if any)..........................................

SCHOOL NAME:.............................................................................................................

FULLNAME OF STUDENT..............................................................................................

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

1.Examination of appearance, blood pressure, heart rate and vision(first examination – at the beginning of an academic year, Second examination - at the beginning of the second Semester)

SIXTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

SEVENTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

EIGHTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

NINTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

2. Abnormalities

Date	Initial diagnosis	Treatment		Remarks
Date	Initial diagnosis	At school (specify treatments)	Referral to (specify receiving facility)	Remarks
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PART 3 – HEALTH SPECIALTY EXAMINATION

(To be completed by specialty physicians or doctors)

Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Paediatrics a) Cardiovascular …………………………………………………………………. ………………………………………………………………………………….. b) Respiratory: ………………………………………………….…………………. ………………………………………………………………………………….. c) Gastrointestinal…………………………………………………..………… ………………………………………………………………………………….. d) Renal-urinary ……………………………………………………………. ………………………………………………………………………………….. dd) Neurologic - Psychiatric……………………………………………………… ………………………………………………………………………………….. e)Others…………………………………………………………………………… …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Eyes a)Vision test: - Unaided: Right eye:……./10 Left eye:……./10 - Aided: Right eye:……./10 Left eye:……./10 b) Eye diseases (if any) ……………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Ear-Nose-Throat a)Hearing test: - Left ear: Conversational voice::…….. m; whispered voice:…….m - Right ear: Conversational voice::…….. m; whispered voice:…….m b) Other related diseases (if any)…………………………………………… ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Oral and maxillofacial system a)Oral and maxillofacial examination: -Maxilla…………………………………………………………………….. ………………………………………………………………………………….. -Mandible…………………………………………………………………….. ………………………………………………………………………………….. b) Oral maxillofacial pathology (if any)…………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Musculoskeletal system a)Musculoskeletal test - Normal □ - Curvature: Kyphosis □ Lordosis □ - Scoliosis S-shaped □ C-shaped □ b) Other musculoskeletal disorders (if any)……………………………… ………………………………………………………………………………….. …………………………………………………………………………………..

Made in A5 (14.8cm x 21cm)

Appendix 01

FORM 01. HEALTH RECORD

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on healthcare in schools dated May 12, 2016 by the Minster of Education and Training)

The front cover

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

HEALTH RECORD

Full name(uppercase)…………..………...Male □ Female □

Date of birth:………………………………………

School name:……………………………………...……………….

District: ………………….……………….

Province:………………….……………….

For students from tenth grade to twelfth grade

(This record shall be kept during the preschool age, in case of change of the school, the student shall submit this record to the new school)

The back cover

PART I – GENERAL INFORMATION

(To be completed by student’s parents)

1. Full name of student(upper case):…………………………….…Male □ Female □

2. Date of birth:………………………………………

3. Full name of student’s father/guardian :....................................................................

Occupation................................................ Contact number..........................................

Current residential address:.......................................................................................

4. Full name of student’s mother/guardian :...................................................................

Occupation................................................ Contact number..........................................

Current residential address:.......................................................................................

5. Birth order:…………………………….. Total number of children::………………………

6. Health history:..................................................................................................

a)Obstetrics:

-Normal □

-Abnormal: Preterm birth □ Postmature birth □ Medical interventions during labour □ Prenatal asphyxia □

-Diseases in pregnancy (specify): ..............................................

.........................................................................................................................................

b) History of diseases: Asthma □ Epilepsy □ Allergy □ Congenital heart diseases □

c) Immunization:

No.	Vaccines	Vaccination
No.	Vaccines	Yes	No	Not sure
1	BCG
2	Diphtheria, pertussis and tetanus
	First dose
	Second dose
	Third dose
3	Polio
	First dose
	Second dose
	Third dose
4	Hepatitis B
	Infants
	First dose
	Second dose
	Third dose
5	Measles
6	Japanese Encephalitis B
	First dose
	Second dose
	Third dose
7	…..

d) If under any treatment or on medication, please state diseases and drug name:

.........................................................................................................................................

7. Changes in residential address or contact number (if any)..........................................

SCHOOL NAME:...............................................................................................................

FULLNAME OF STUDENT.................................................................................................

PART II – HEALTH EXAMINATION

(To be completed by school’s examining doctors)

1.Examination of appearance, blood pressure, heart rate and vision (first examination – at the beginning of an academic year, Second examination - at the beginning of the second Semester)

TENTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

ELEVENTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

TWEFTH GRADE………………….. ACADEMIC YEAR…………………..

First examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

Blood pressure:Diastolic ……./mgHg Systolic……/mgHg

Heart rate:……….bpm

Vision test:Unaided: Right eye:……./10 Left eye:……./10

Aided: Right eye:……./10 Left eye:……./10

Second examination

Examining doctor
(Signature and full name)

Physical status:Height:………m; Weight:………kg;

Body Mass Index (BMI):………………….. (kg/m²)

2. Abnormalities

Date	Initial diagnosis	Treatment		Remarks
Date	Initial diagnosis	At school (specify treatment methods)	Referral to (specify receiving facility)	Remarks
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……/…../………
……/…../………
……/…../………

PART 3 – HEALTH SPECIALTY EXAMINATION

(To be completed by specialty physicians or doctors)

Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Paediatrics a) Cardiovascular …………………………………………………………………. ………………………………………………………………………………….. b) Respiratory: ………………………………………………….…………………. ………………………………………………………………………………….. c) Gastrointestinal…………………………………………………..…………… ………………………………………………………………………………….. d) Renal-urinary ……………………………………………………………. ………………………………………………………………………………….. dd) Neurologic - Psychiatric……………………………………………………… ………………………………………………………………………………….. e)Others…………………………………………………………………………… …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Eyes a)Vision test: - Unaided: Right eye:……./10 Left eye:……./10 - Aided: Right eye:……./10 Left eye:……./10 b) Eye diseases (if any) ……………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Ear-Nose-Throat a)Hearing test: - Left ear: Conversational voice::…….. m; whispered voice:…….m - Right ear: Conversational voice::…….. m; whispered voice:…….m b) Other related diseases (if any)…………………………………………… ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Oral and maxillofacial a)Oral and maxillofacial examination: -Maxilla…………………………………………………………………….. ………………………………………………………………………………….. -Mandible…………………………………………………………………….. ………………………………………………………………………………….. b) Oral maxillofacial pathology (if any)…………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..
Date of examination …./…./…….Examining physician/doctor (Signature and full name)	Musculoskeletal system a)Musculoskeletal test - Normal □ - Curvature: Kyphosis □ Lordosis □ - Scoliosis S-shaped □ C-shaped □ b) Other musculoskeletal disorders (if any)……………………………… ………………………………………………………………………………….. …………………………………………………………………………………..

Made in A4 (21cm x 29.7cm)

Appendix 01

FORM 02. INTEGRATED HEALTH RECORD

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 12, 2016 by the Minister of Education and Training and Minister of Health)

The front cover

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

INTEGRATED HEALTH RECORD

SCHOOL NAME:..........................................................................

District: ………………….……………….

Province………………………..

LIST OF MALNOURISHED STUDENTS

ACADEMIC YEAR:………………………………..

No.	Student’s full name	Gender		Grade	Date of discovery	Diagnosis	Treatment	Remarks
No.	Student’s full name	Male	Female			At school (specify treatments)	Referral to (specify receiving facility)

LIST OF OVERWEIGHT OR OBESE STUDENTS

ACADEMIC YEAR:………………………………..

No.	Student’s full name	Gender		Grade	Date of discovery	Diagnosis	Treatment	Remarks
No.	Student’s full name	Male	Female			At school (specify treatments)	Referral to (specify receiving facility)

LIST OF STUDENTS SUFERRING FROM CARDIOVASCULAR DISEASES

ACADEMIC YEAR ……………………………………..

No.	Student’s full name	Gender		Grade	Date of discovery	Diagnosis	Treatment	Remarks
No.	Student’s full name	Male	Female			At school (specify treatments)	Referral to (specify receiving facility)

LIST OF STUDENTS SUFERRING FROM EYE DISEASES

ACADEMIC YEAR:………………………………..

No.	Student’s full name	Gender		Grade	Date of discovery	Diagnosis	Treatment	Remarks
No.	Student’s full name	Male	Female			At school (specify treatments)	Referral to (specify receiving facility)

LIST OF STUDENTS SUFERRING FROM MUSCULOSKELETAL DISORDERS

ACADEMIC YEAR:………………………………..

No.	Student’s full name	Gender		Grade	Date of discovery	Diagnosis	Treatment	Remarks
No.	Student’s full name	Male	Female			At school (specify treatments)	Referral to (specify receiving facility)

LIST OF STUDENTS SUFFERING FOR ORAL DISEASES

ACADEMIC YEAR:………………………………..

No.	Student’s full name	Gender		Grade	Date of discovery	Diagnosis	Treatment	Remarks
No.	Student’s full name	Male	Female			At school (specify treatments)	Referral to (specify receiving facility)

LIST OF STUDENTS SUFFERING FROM MENTAL DISORDERS

ACADEMIC YEAR:………………………………..

No.	Student’s full name	Gender		Grade	Date of discovery	Diagnosis	Treatment	Remarks
No.	Student’s full name	Male	Female			At school (specify treatments)	Referral to (specify receiving facility)

Made in A4 (21cm x 29.7cm)

Appendix 02

MẪU BÁO CÁO CÔNG TÁC Y TẾ TRƯỜNG HỌC
(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 12, 2016 by the Minister of Education and Training and Minister of Health)

[School name]

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

………..[Location and date]…..

HEALTH ASSESSMENT REPORT

1. General information

1. Number of students:………………………….. Number of teachers………………………

2. Number of classes…………………………….

3. Student Heath Advisory Board: Yes □ No □

4. Approved student health plan(s): Yes □ No □

5. Amount of funding:………………………..VND

II. Student healthcare

2.1. Detection of health problems and abnormalities

No.	Health problems	Number of problems	Treatment/referral	Percentage (%)
1.	Malnourished
2.	Overweight, obese
3.	Oral Diseases
4.	Eye diseases
5.	Cardiovascular system
6.	Respiratory system
7.	Neurological - Psychiatric
8.	Musculoskeletal system
9.	Others (please, specify)
10.	………….
Total

*Percentage (%)= (number of treated problems or referrals x 100)/ total number of problems

Comments: ………………………………………………………………………………………………

2.2. Medical examination and treatment by specialty

No.	Specialties	Number of student undergoing examination	Number of ill students	Number of students in treatment	Percentage (%)
1.	Peadiatrics/ internal medicine
2.	Ophthalmology
3.	Otorhinolaryngology
4.	Oral and maxillofacial surgery
5.	Othorpaedic surgery
6.	Psychiatry
7.	Others(please, specify)
8.	……………..
Total

Percentage (%) = (Total number of students in treatment x 100)/total number of ill students

Comments: ………………………………………………………………………………………………

2.3. Infectious disease and epidemic status

No.	Name of disease/epidemics	Number of ill students	Mortality	Remarks
1.	Diarrhea
2.	Hand-Foot-Mouth
3.	Measles
4.	Mumps
5.	Others(please, specify)
6.	………..
Total

Comments:

…………………………………………………………………………………………………………..

…………………………………………………………………………………………………………

2.4. First aid and emergency administration

No.	Type of accidents	Number of injuries	Treatment/referral	Percentage (%)
1.	Slip and fall
2.	Burn
3.	Drowning
4.	Electrocution
5.	Bitten by livestock
6.	Poisoning
7.	Choking
8.	Cutting
9.	Getting hit
10.	Traffic accidents
11.	Others(please, specify)
12.	………….
	Total

*Percentage (%)= (number of treated injuries or referrals x 100)/ total number of injuries

Comments:

……………………………………………………………………………………………………

2.5.Healthcare advisory services

No.	Advices on	Potential patients	Number of students given advices	Percentage (%)
1.	Nutrition regimen
2.	Physical activities
3.	Psychological aspects
4.	Disease prevention
5.	Compulsory schooling disease prevention
6.	Mental health
7.	Others(please, specify)
8.	……………….

*Percentage = (number of students given advices x100)/ total number of potential patients

Comments:

………………………………………………………………………………………………………

2.5. School meals

- Does your school provide lunch/or both dinner and lunch: Yes □ No □

Are they healthy meals?: Yes □ No □

Comments:

………………………………………………………………………………………………………

2.6 .Vaccination in schools

No.	Vaccines	Total number of students	Number of vaccinated students	Percentage (%)
1.
2.
3.	…………

*Percentage % = (number of vaccinated students x100)/ the total number of students

Comments:

……………………………………………………………………………………………………

2.7. Health record management

- Number of students having health records:………………………

- Number of health records and integrated health records regularly updated:………….; ………………..%

- Number of students whose health status is notified to their parents/guardian…………

Comments:

……………………………………………………………………………………………………

2.8. Achievements in proactive execution of disease prevention measures

No.	Activities	Repetitions	Remarks
1	School and class room full cleaning
2	Insecticide spraying
3	Toys and teaching tools cleaning and disinfecting
4	Canteen cleaning
5	Water sources purification
6	Waste collection and treatment
7	Others(please, specify)

Comments:

………………………………………………………………………………………………………

2.9. Execution of health and hygiene campaigns

No.	Campaigns	Yes	No	Remarks
1	HIV/AIDS prevention
2	Accident prevention
3	Infectious disease prevention and control
4	Malnutrition prevention
5	Food safety
6	Smoke-free campaign
7	Alcohol-free campaign
8	Health education
9	Others(specify)

Comments:………………………………………………………………………………………

2.10. School health financial statement

No.	Elements	Amount	Remarks
1	Total funding
2	Funding from the State’s budget
3	Funding from student health insurances
4	Others

Comments:

………………………………………………………………………………………………………

III. Health education programs

3.1. Does your school compile documents for health education according to the actual diseases within the province:Yes □ No □

3.2.Does your school have any health education collumn?Yes □ No □

3.3.Does your school provide healthcare education?

No.	Activities	Repetitions	Number of participants	Remarks
1	Infectious disease prevention and control
2	Food poisoning prevention
3	Diet
4	Physical activities
5	Smoke-free campaign
6	Alcohol-free campaign
7	Communicable disease prevention
8	Oral health
9	Eye disease prevention
10	Accident prevention
11	Others(specify)

Comments:

………………………………………………………………………………………………………

IV. Requirements for healthcare

No.	Elements	Available	Not available	Remarks
1	First aid rooms
2	first aid rooms qualified for student healthcare
3	Health examination records
4	Health records
5	Integrated health records
6	Medical staff

Comments:

……………………………………………………………………………………………………………….

V. Requirements for facilities, water supply and drainage, environmental hygiene and food safety.

No.	Elements	Satisfactory	Unsatisfactory	Remarks
1	Classrooms
2	Desks and chairs
3	Chalkboards
4	Lighting systems
5	Preschool toys and teaching tools
6	Drinking water
7	Domestic water
8	Sanitation infrastructures
9	Waste collection and treatment
10	Food safety

Comments: ………………………………………………………………………………………

VI. Execution of school health policies and development of social relationships in schools and community

No.	Elements	Yes	No	Remarks
1	The Student Health Advisory Committee clarifies member’s responsibilities and hold meetings at least once a semester
2	The school complies with school policies and regulations
3	teacher-student and student-student relationships are deepened
4	School- students’ parent relationships and school-community relationships are created

Comments:

……………………………………………………………………………………………………

VII. Assessment of healthcare activities in schools

-Carry out self-assessment of school healthcare achievements and limitations using the form prescribed in the Joint Circular No…………… /TTLT-BYT-BGDDT dated…………may, 2016: Yes □ No □

Overall score:

Ranking: Excellent □ Good □ Average□ Unsatisfactory □

- Assessed by supervisory authority: Yes □ No □

Overall score:

Ranking: Excellent □ Good □ Average□ Unsatisfactory □

Comments:

………………………………………………………………………………………………………

……………………………………………………………………………………………………………..

Proposals:

………………………………………………………………………………………………………

For the school
(Sign and seal)

…………………..[date]
Reporter
(Sign and signature)

Made in A4 (21cm x 29.7cm)

Appendix 03

[School name]

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

………..………..[Location and date]…..

ASSESSMENT OF HEALTHCARE ACTIVITIES IN SCHOOLS
(For preschool education institutions)

I. General information

1. School name: ………………………………………………..

Commune:………………….……………….District: ………………….……………….

Province:………………….……………….

2. Total classrooms:……………Total teachers:………….…total students………..

3. Methods of assessment: Self-assess □ Assesses by supervisory authority □

4. Date:……………………………….

II. Assessment results

No.	Elements	Benchmark	Score
I	Preparation and execution of school health plans	5.0
1.1.	Student Heath Advisory Board	2.0
	Have a Decision on Establishment of the Student Health Advisory Board and define responsibilities of members	1.0
	Hold meetings at least once a semester	1.0
1.2.	Annual school health plans	3.0
	Have school health plan(s) by academic year approved	1.0
	Have all school health contents included in the plan under regulations of laws.	1.0
	Have funding for annual school health plan available	1.0
II.	Facilities	10
2.1.	Social halls and bed rooms	2.0
2.1.1	Social halls	1.0
	Have the floor space per student of 1.5-1.8m²and floor area of at least 24 m²per room (for groups) and 36m² per room (for preschooler classroom)	0.5
	Receive sufficient natural light and air ventilation	0.3
	Have teaching tools and toys equipped available	0.2
2.1.2	Bedrooms	1.0
	Have the floor space per child of 1.2-1.5m² and floor area of at least 18 m²per room (for groups) and 30m² per room (for preschooler classroom)	0.5
	Have bed rooms always kept quiet and proper temperature	0.3
	Have mattress, mats, cabinets, closets and shelves available	0.2
2.2	Student’s desks and chairs	3.0
	Use two-seat desks or four-seat desks with smooth face and separate chairs	1.0
	Have 03 different sizes called A, B and C according to student age groups	1.0
	Have the height of desk and chair designed according to students’ height. The difference in the height of desk and chair is at least 200mm and not exceeding 270 mm.	1.0
2.3	Chalkboards (if any)	1.0
	Provide adequate chalkboards as required in the Circular No.02/2010/TT- BGDDT on lists of essential teaching tools-toys-utensils for preschoolers dated February 11, 2010 by the Minister of Education and Training.	0.5
	Be safe, durable and useful.	0.5
2.4	Lighting systems	2.0
	Have social halls, bathrooms, restrooms, playground, canteens designed to receive sufficient natural light.	0.5
	The ratio of windows to floor area is at least 1/5	0.5
	Have corridors and stairs artificially illuminated with the luminance of at least 100 lux, and other rooms lighted with the allumiance of at least 300 lux.	1.0
2.5	Toys	2.0
	Use only toys which are conformable to provisions of toy safety in the Circular No./2011/TT- BGDDT dated April 13, 2011 by the Ministry of Education and Training	1.0
	Provide preschoolers with educational and esthetic toys that may help them develop their physical, linguistic, emotional, aesthetic and social skills	0.5
	Suit local customs and student’s psychology.	0.3
	Keep toy closets tidy and clean	0.2
III	Water supply and drainage and environmental hygiene	10
3.1	Drinking and domestic water supply	3.0
	Provide sufficient drinking water in the quantity of at least 0.5 liter per student per class in summer and 0.3 liter per student per class in winter.	1.0
	Provide sufficient domestic water in a quantity of at least 4 liters per student/class. If the domestic water is distributed through pipeline, have each nozzle designed to meet the need of not exceeding 200 students per class;	0.5
	Provide sufficient drinking water and domestic water in the minimum quantity of 100 liters per student per 24 hours (for boarding schools);	0.5
	Meet water quality requirements of the Ministry of Health	0.5
	Have wells, water tanks or water jar (if any) covered and constructed or situated in a proper locations to ensure the student safety under regulations of laws.	0.5
3.2	Sanitation infrastructures	4.0
	Have restrooms attached with social halls and bed rooms or classrooms for each separate gender of teachers and students.	0.5
	Provide enough space with the ratio of 0,4 m²- 0,6 m²per student but not under 12 m²/room	0.5
	Have urinals and toilet separated with partition of at least 1.2 m in height.	0.5
	Have enough space to installed toilets with the area of 0.8m x 0.7m	0.5
	Provide 2-3 urinals for male students and 2-3 toilets for female students.	0.5
	Have hand wash area available , one wash basin for 8-10 students, hand wash soap or similar liquid available.	1.0
	Provide easy-to-use sanitary ware and fixtures according students’ age group	0.5
3.3	Waste collection and treatment	3.0
	Have storm water and domestic water drainage ditches available; no water stagnation	1.0
	Have recycle bins available and get wastes classified	1.0
	Enter into contracts for wastes collection and treatment with eligible facilities or collect and treat their wastes on their own under regulations of laws	1.0
IV	Food safety	10
4.1	Canteens	4.0
	Receive sufficient natural light and have mosquito nets available	0.5
	Have smooth and easy-to-clean walls and ceiling	0.5
	Use tables, chairs and fixtures made of easy-to-clean materials	0.5
	Have sufficient tables, chairs and necessary furniture	0.5
	Use food storage containers or similar things made from easy-to-clean and harmless materials	0.5
	Have means for storage food available	0.5
	Have adequate items for cleaning and sterilizing	0.5
	Have hand wash areas, clean water, soap or antiseptic liquid available	0.5
4.2	Kitchens	2.0
	Have areas for food processing, cooking, food and ingredient storage and eating area.	0.5
	Have food processing area designed according to one-way-flow principle, classify utensils used for fresh food and cooked food.	1.0
	Have food samples stored under regulations of laws	0.5
	In case of outsourcing: Sign contracts for student meal provision with eligible facilities	2.0
4.3	Food storage areas	1.0
	Receive sufficient natural light, air ventilation and have mosquito net installed in windows.	0.3
	Be covered with smooth and easy-to-clean walls and ceiling	0.2
	Have tools used for classifying and storing food	0.5
4.4	Canteen staff	3.0
	Obtain certificates of completion of training courses in food safety	1.0
	Obtain the Health Certificate under regulations of the Ministry of Health	1.0
	Wear protective clothes, specialized gloves, masks and hat.	1.0
V	Execution of school health policies and development of social relationships within schools and community	10
5.1	Implementation of school policies and regulations on school health.	4.0
	Introduce regulations on personal and environmental hygiene and implement such regulations	0.5
	Introduce and apply regulations on accident preventions	0.5
	Introduce and apply regulations on food safety	0.5
	Introduce and apply healthy meals	0.5
	Introduce and participate in physical activities	0.5
	Define responsibilities of teachers and baby-sitters	0.5
	Introduce regulations on cooperation in student healthcare between school, parents and community	0.5
	Apply proper curricula and schedule to spare leisure time for students; create favorable study environment	0.5
5.2	Development of teacher-student and student-student relationships	3.0
	Comply with rules of conducts; treat students with respect, promote gender equality, prevent racial and religious discrimination and violence	2.0
	Assist students in dilemma or students having difficulties in social inclusion	1.0
5.3	Development of school- parent relationships and school-community relationship	3.0
	Instruct students’ parents in provision of learning conditions for their children at home	0.5
	Mobilize local government and regulatory bodies to facilitate the school health performance	1.0
	Participate in sporting and cultural activities held by local government to create relations with local government and local regulatory bodies	0.5
	Cooperate with local medical authorities to carry out school health services	1.0
VI	Student health care	10
6.1	First aid rooms	5.0
	Have their own first aid rooms covered a required area	1.0
	Be located in convenient locations	0.5
	Have at least 01 sickbed available	0.5
	Have desks, chairs, cabinets and essential tools	1.0
	Have essential drugs for students available	1.0
	Have health examination records, health records and integrated health records available.	1.0
6.2.	Medical staff	5.0
	Acquire at least an associate degree in physician assistant.	2.0
	Enter into contracts for school health with medical stations of communes or at least general medical examination and treatment facilities in case that there are no medical staff or medical staff fail to acquire the associate degree in medicine.	2.0
	Regularly attend health seminars, or training courses held by health and education authorities;	3.0
VII	School healthcare and management	20
	Carry out health examination at the beginning of every academic year (measuring the height and weight of under-36-month-students; and the height and weight, blood pressure, heart rate and visual acuity of older-36-month-students )	2.0
	Measure the height and weight and record physical developmental milestone charts of under-24- month children monthly and above-24-month children quarterly.	2.0
	Regularly examine student’s health, nutritional status, obesity, overweight, oral diseases and other diseases to apply proper treatments and referrals or a proper learning environment and physical exercises.	2.0
	Cooperate with qualified medical facilities to carry out specialty examination and treatment.	1.0
	Administer first aid and emergency treatment (if any) under current regulations of the Minister of Health.	1.0
	Provide students, their parents or guardians and teachers with advice on common diseases, student physical and mental development and healthcare; in case of disabled students, assist them in inclusive education.	1.0
	Provide instructions on healthy meal, diversified food and nutrition according to students’ age group	1.0
	Cooperate with local medical facility to administer vaccines to students.	1.0
	Notify students’ parrents or guardians of their child’s health at least once an academic year or where necessary.	1.0
	Record the student health in their health examination record, health record and integrated health record.	2.0
	Regularly inspect and supervise the study environment, school hygiene, food safety, drinking water and hand wash liquid or soap.	2.0
	Proactively implement measures for preventing and controlling diseases under the Circular No.46/2010/TT-BYT and other instructions of medical authorities.	2.0
	Conduct medical programs and hygiene campaigns, participate in physical exercises and healthy meal, .	2.0
VIII	Health education	15
	Compile and use documents on health education by student age group and the local reality.	1.0
	Propagate and provide education about measures for preventing (1) infectious disease; (2) food poisoning ; (3) accidents; (4) nutrition and physical activities; (5) compulsory schooling diseases; (6) oral diseases; (7) eye diseases (1.0 score for each item)	7.0
	Include health education in lectures.	1.0
	Get students participate in (1) personal hygiene; (2) school and environment cleaning; (3) healthy meals; (4) physical exercises;(5) oral health; (6) eye health via proper models and methods(1.0 score for each item )	6.0
IX	Report and assessment	10
	Submit annual school health report by the end of every academic year	3.0
	Carry out annual school health self-assessment under regulations of laws	5.0
	Apply assessment comments to draw up school health plans	2.0
	Overall score	100

Assessment and ranking

1. Overall score:……………….

2. Compulsory criteria: Satisfactory □ Unsatisfactory □

3. Ranking: Excellent □ Good □ Average □ Unsatisfactory □

Representative of Inspectorate
(Signature and full name)

Representative
(Signature and full name)

INSTRUCTION ON SCORING

1. Rules for scoring

-Only mark “yes” criteria/elements.

-Optional criteria/elements are marked according to the benchmark.

-The criteria/elements completely fulfilled shall be awarded 100% of the benchmark, those partially fulfilled shall be marked 50% of the benchmark.

2. Assessment:

-The maximum score: 100

a)Schools ranked as excellent:

A school will be ranked excellent if its overall score is at least 90 and occupies at least 80% of the benchmark of every compulsory criteria.

-Compulsory criteria:

+ Facilities, water supply and drainage, environmental hygiene, food safety, student healthcare(≥ 32 scores)

+Execution of school health policies and development of social relationships between schools and community(≥ 8.0 scores)

+School health management and education (≥ 16 scores)

+Health education and propagation(≥ 12.0 scores)

b) Schools ranked as good

A school will be ranked as good if it achieves an overall score percentage of from 70 – <90% of the benchmark;and there may be one criteria under 70% of the benchmark.

c)Schools ranked average:

A school will be ranked average if it gets 50 -<70% of the benchmark;and there may be one criteria under 50% of the benchmark

dd) School ranked unsatisfactory:
A school is ranked unsatisfactory if it fail to get the overall score of 50% of the benchmark.

Made in A4 (21cm x 29.7cm)

Appendix 04

(Issued together with the Joint Circular 13/2016/TTLT-BYT-BGDDT on regulations on healthcare activities in schools dated May 12, 2016 by the Minister of Education and Training and Minister of Health)

[School name]………………

THE SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
----------------

………..………..[Location and date]…..

ASSESSMENT OF HEALTHCARE ACTIVITIES IN SCHOOLS
(For high schools)

I. General information

1. School name: ………………………………………………..

Commune:………………….……………….District: ………………….………………. Province………………………..

2. Total classrooms:……………Total teachers:………….…total students………..

3. Methods of assessment: Self-assess □ Assessed by the supervisory authority □

4. Date:……………………………….

II. Assessment results

No.	Elements	Benchmark	Score
I	Preparation and execution of school health plans	5.0
1.1.	Student Heath Advisory Board	2.0
	Have a Decision on Establishment of the Student Health Advisory Board and have responsibilities of members define	1.0
	Hold meetings at least once a semester	1.0
1.2.	School health plans by academic year and period	3.0
	Have school health plans by academic year approved	1.0
	Have all school health contents included in the plan under regulations of laws.	1.0
	Have funding for school health plan available	1.0
II.	Facilities	10
2.1.	Classrooms	2.0
	Have the average floor space per student of at least 1.25m²(for primary schools) and 1.5 m²(for lower secondary schools)	0.5
	Have every classroom installed with 02 two-wing doors with the width of at least 1.0 m at both ends of the classroom and towards the corridor.	0.3
	Have each classroom separated and partitioned from rooms which are noisy, dusty, or filled with noxious gases or fouling smell.	0.3
	Have every classroom designed to receive sufficient natural ventilation and installed with artificial ventilation systems such as, ceiling fans, wall mounted fans, exhaust fans, and the CO₂concentration not exceeding 0.1 %	0.4
	Keep the noise in classrooms not exceeding 55 dBA	0.5
2.2	Classrooms for physics, chemistry and biology	1.0
	Have minimum floor space per student of 1.85 m² (for lower secondary schools) and 2 m²(for high schools)	0.2
	Have the room designed with the height of at least 3.30 m, and minimum width of 7.2 m; ratio of length to height of not exceeding 2; preparation rooms with the area of at least 12m²to not exceeding 27m²connected with such classrooms by door.	0.2
	Have each room installed with two doors at both ends	0.2
	Keep CO₂concentration not exceeding 0.1 % and concentration of other chemicals remained within permissible limits.	0.2
	Have notice boards and safety manuals put up at remarkable places	0.2
2.3	IT practice rooms	0.5
	Provide minimum floor space per student of 2.25 m² (for lower secondary schools) and 2.45 m²(for upper secondary school)	0.3
	Have practice rooms designed to receive natural ventilation, CO₂concentration not exceeding 0.1% and keep student safe from electromagnetic field under regulations of laws	0.2
2.4	Student desks and chairs	3.5
2.4.1	In classrooms	2.5
	Use 02-seat smooth desks or one-seat desks. Desks and chairs are separate from each other separate.	1.0
	Have 6 different sizes I, II, III, IV, V and VI according to student s height prescribed in the Joint Circular No.26/2011/BGD&DT-BKHCN-BYT on standards about desks and chairs for students in primary schools, lower secondary schools and high schools dated June 16, 2011; and have such desks and chairs arranged in accordance with regulations of laws	1.5
2.4.2	In classrooms for physics, chemistry and biology	0.5
	Have dedicated desks and chairs to meet specific demand of each subject, electricity system, water and gas systems	0.5
2.4.3	In IT practice rooms	0.5
	Dedicated desks and chairs to meet the need of the subject	0.5
2.5	Chalkboards	1.0
	Use anti-glare chalkboards that meet the required contrast between handwriting and the chalkboard color.	0.5
	Use chalkboards with the height of from 1.2 m to not exceeding 1.5 m, and the width of not exceeding 3.2m according to the width of the classroom and have such chalkboard put up in conformity with regulations of laws.	0.1
	Use dark green boards or blackboards (if white chalks are used) or whiteboards (if markers are used);	0.1
	Have such chalkboards put up in the middle of the wall, the distance from the lower edge to the floor of from 0.8m to not exceeding 1m	0.3
2.6	Lighting systems	2.0
2.6.1	In common classrooms	1.0
	Take natural light from the South or Southeast on the student’s left hand (windows are installed in the opposite direction to corridors); ratio of total window area to floor area at least 1/5	0.2
	Have classrooms installed with artificial lighting systems, ceiling lights with light shades which are put up below ceiling fans and paralleled with the wall having window. The distance from the light to wall is at least 1.2m to 1.5 m, and switches is installed on each wall.	0.2
	Have studying area illuminated with the lluminous coefficient not under ½ and illuminance of at least 300 lux	0.5
	Have lights for chalkboards paralleled with the chalkboard wall, 0.6 m distant from the wall and 0.3 m higher than the upper edge of the chalkboard.	0.1
2.6.2	In classrooms for physics, chemistry and biology	0.5
	Satisfy illumination requirements, and utilize both natural light (from the student’s left hand) and artificial light (for local and general illumination) with the luminance of at least 300 Lux	0.5
2.6.3	InT practice rooms	0.5
	Have every computer desk illuminated with the luminance of at least 300 Lux	0.5
III	Water supply and drainage and environmental hygiene	10
3.1	Drinking and domestic water supply	3.0
	Provide sufficient drinking water in the quantity of at least 0.5 liter per student per class in summer and 0.3 liter per student per class in winter.	1.0
	Provide sufficient domestic water in a quantity of at least 4 liters per student/class. If the domestic water is distributed through pipeline, have each nozzle designed to meet the need of not exceeding 200 students per class;	0.5
	Provide sufficient drinking water and domestic water in the minimum quantity of 100 liters per student per 24 hours (for boarding schools);	0.5
	Satisfy water quality requirements of the Ministry of Health	0.5
	Have wells, water tanks or water jar (if any) covered and constructed or situated in a proper height to ensure the student safety under regulations of laws.	0.5
3.2	Sanitation infrastructures	4.0
	Have sanitation infrastructures constructed in a suitable location that is convenient for both students and teachers and prevents environmental pollution	0.2
	Have sanitation areas for teacher and students, and male and female separated	0.5
	Have clean water, soap or antiseptics liquid available in every restroom	1.0
	Have restrooms constructed in accordance with QCVN 01: 2011/BYT	0.5
	Meet the required of fixtures: 01 urinal, 01 toilet and 01 wash basin for 20 – 30 students (for male), and 20 students per toilet (for female)	1.0
	Have the entrance ways of restrooms not located in opposite to that of any classroom or office. Every fixture shall be installed at the proper height according to the demand and age group of students	0.2
	Have restroom use regulations put up.	0.2
	Have bulking agents, water, and toilet paper and recycle bins available.	0.4
3.3	Waste collection and treatment	3.0
	Have storm water and domestic water drainage ditch; no water stagnation	1.0
	Have recycle bins available and wastes classified	1.0
	Sign contracts for wastes collection and treatment with eligible facilities or collect and treat their wastes on their own under regulations of laws	1.0
IV	Food safety	10
4.1	Canteens	4.0
	Receive sufficient natural light and have mosquito net available	0.5
	Be covered with smooth and easy-to-clean walls and ceiling	0.5
	Use tables, chairs and fixtures made from easy-to-clean materials	0.5
	Have sufficient tables, chairs and necessary furniture available	0.5
	Use food storage containers or similar things made from easy-to-clean and harmless materials	0.5
	Have means for storage food available	0.5
	Have adequate items for cleaning and sterilizing	0.5
	Have hand wash areas, clean water, soap or antiseptic liquid available	0.5
4.2	Kitchens	2.0
	Have areas for food processing, cooking, food and ingredient storage and eating area.	0.5
	Have food processing area designed by one-way-flow principles, classify utensils used for fresh food and cooked food.	1.0
	Have food samples stored under regulations of laws	0.5
	In case of outsourcing: Enter into contracts for student meal provision with eligible facilities	2.0
4.3	Food storage areas	1.0
	Receive sufficient natural light, air ventilation and have mosquito net installed in windows .	0.3
	Be covered with smooth and easy-to-clean walls and ceiling	0.2
	Have tools used for classifying and storing food available	0.5
4.4	Canteen staff	3.0
	Obtain certificates of completion of training courses in food safety	1.0
	Obtain Health certificates under regulations of the Ministry of Health	1.0
	Wear protective clothes, specialized gloves, masks and hat.	1.0
V	Execution of school health policies and development of social relationships within schools and community	10
5.7	Implementation of school policies and regulations on school health.	4.0
	Introduce regulations on personal and environmental hygiene and implement such regulations	0.5
	Introduce and apply regulations on accident preventions	0.5
	Introduce and apply regulations on food safety	0.5
	Introduce and apply healthy meals	0.5
	Introduce and participate in physical activities	0.5
	Define responsibilities of teachers and baby-sitters	0.5
	Introduce regulations on cooperation in student healthcare between school, parents and the community	0.5
	Apply proper curricula and schedule to spare leisure time for students; create favorable study environment	0.5
5.2	Development of teacher-student and student-student relationships	3.0
	Comply with rules of conducts; treat students with respect, promote gender equality, prevent racial and religious discrimination and violence	2.0
	Assist students in dilemma or students having difficulties in social inclusion	1.0
5.3	Development of school- parent relationships and school-community relationship	3.0
	Instruct students’ parents in provision of learning conditions for their children at home	0.5
	Mobilize local government and regulatory bodies to facilitate the school health performance	1.0
	Participate in sporting and cultural activities held by local government to create relations with local government and local regulatory bodies	0.5
	Cooperate with local medical authorities to carry out school health services	1.0
VI	Student health care	10
6.1	First aid rooms	5.0
	Have their own first aid rooms covered a required area	1.0
	Be located in convenient locations	0.5
	Have at least 01 sickbed available	0.5
	Have desks, chairs, cabinets and essential tools	1.0
	Have essential drugs for students available	1.0
	Have health examination records, health records and integrated health records available.	1.0
6.2	Medical staff	5.0
	Acquire at least an associate degree in physician assistant	2.0
	Enter into contracts for school health with medical stations of communes or general medical examination and treatment facilities in case that there are no medical staff or medical staff fail to acquire the associate degree in medicine.	2.0
	Regularly attend health seminars, training courses held by health and education authorities;	3.0
VII	School healthcare and management	20
	Carry out health examination at the beginning of every academic year by measuring students’ height, weight, blood pressure, heart rate and visual acuity.	2.0
	Monitor BMI, nutritional status to give appropriate advice on healthy diet regimens and physical activities	2.0
	Regularly examine student’s health, visual acuity, curvature of spine, and other diseases to give proper treatments, referral or provide suitable learning environment and physical exercises.	2.0
	Cooperate with qualified medical facilities to carry out specialty examination and treatment.	1.0
	Administer first aid and emergency treatment (if any) under current regulations of the Minister of Health.	1.0
	Provide students, their parents or guardians and teachers with advice on common diseases, student physical and mental development and healthcare; in case of disabled students, assist them in inclusive education.	1.0
	Provide instructions on healthy meal and diversified foods according to student age groups ( for boarding schools and semi-boarding schools)	1.0
	Cooperate with local medical facilities to administer vaccines to students.	1.0
	Notify students’ parrents or guardians of their child’s health at least once an academic year or where necessary.	1.0
	Record the student health in their health examination record, health records and integrated health record.	2.0
	Regularly inspect and supervise the study environment, school hygiene, food safety, drinking water and hand wash.	2.0
	Proactively implement measures for preventing and controlling diseases under the Circular No.46/2010/TT-BYT dated December 29, 2010 by the Ministry of Health and other instructions of medical authorities.	2.0
	Conduct medical programs and hygiene campaigns, participate in physical exercises and healthy diet, alcohol-free and smoke-free campaigns .	2.0
VIII	Health education	15
	Compile and use documents on health education according to student age groups and the local reality.	1.0
	Propagate and provide education about measures for preventing (1) infectious disease; (2) food poisoning ; (3) accidents; (4) nutrition and physical activities; (5) compulsory schooling diseases; (6) oral diseases; (7) eye diseases ( 1.0 score for each item)	7.0
	Include health education in lectures.	1.0
	Get students participate in (1) personal hygiene; (2) school and environment cleaning; (3) healthy meals; (4) physical exercises;(5) oral health; (6) eye health via proper models and methods(1.0 score for each item )	6.0
IX	Report and assessment	10
	Submit annual school health report by the end of every academic year	3.0
	Carry out annual school health self-assessment under regulations of laws	5.0
	Apply assessment comments to draw up school health plans	2.0
Overall score		100

Assessment and ranking

1. Overall score:……………….

2. Compulsory criteria: Satisfactory □ Unsatisfactory □

3. Ranking: Excellent □ Good □ Average □ Unsatisfactory □

Representative of Inspectorate
(Signature and full name)

Representative
(Signature and full name)

INSTRUCTION ON SCORING

1. Rules for scoring

-Only mark “yes” criteria/elements.

-Optional criteria/elements are marked according to benchmarks.

-The criteria/elements completely fulfilled shall be awarded 100% of the benchmark, those partially fulfilled is marked 50% of the benchmark.

2. Assessment:

-The maximum score: 100

Schools ranked as excellent:A school will be ranked excellent if its overall score is at least 90 and occupies at least 80% of the benchmark of every compulsory criteria.

-Compulsory criteria:

+ Facilities, water supply and drainage, environmental hygiene, food safety, student healthcare (≥ 32 scores)

+Execution of school health policies and development of social relationships between schools and community(≥ 8.0 scores)

+School health management and education(≥ 16 scores)

+Health education and propagation(≥ 12.0 scores)

b) Schools ranked as good

A school will be ranked as good if it achieves an overall score percentage of from 70 – <90% of the benchmark. There may be one criteria scored under 70% of the benchmark.

c) Schools ranked average:

A school will be ranked average if it gets 50 -<70% of the benchmark; and there may be one criteria under 50% of the benchmark.

dd) Schools ranked unsatisfactory:

A school will be ranked unsatisfactory if it fail to reach 50% of the benchmark..

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Joint Circular No. 13/2016/TTLT-BYT-BGDDT dated May 12, 2016 of the Ministry of Health and the Ministry of Education and Training on regulations on healthcare activities in schools

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