Albina Health Upload Center

For security purposes, please trace the line below*
Albina Health Upload Center
Your Role*
Document(s) to Upload (Include all pages)

Well Child Exam/Vision/HearingDental Exam/ScreeningImmunization DocumentationMedical/Dental ResultsRelease of Information (MECP- ROI)All Smiles Dental Permission FormMeal Preference Form
STAFF ONLY (Uploads and Screenings Performed by Staff):

Medication Administration Plan (M.A.P.) and Medication PhotosEmergency Form Classroom Upload Pack (Must contain all children in classroom in alphabetical order in ONE FILE. Do not upload each child separately.)Health Concerns and Action Plans Signed by Teacher/Home VisitorGrowth Assessment Performed by StaffHB Only: Hearing or Vision Performed by Staff
Child's Name

First NameLast Name
Program
If currently enrolled in Early Head Start with plans to enroll in Head Start for the upcoming program term, select "Albina Early Head Start".
Your Email:
example@example.com
Please upload BOTH the MAP and a photo of the medication label diplaying Name, Dosage Instructions, Provider and Expiration
Upload Health Documentation*

Cancelof
Assessment
Infant 6 weeks – 12 months Vision Screening: Use the “SEVEN KEY VISION DEVELOPMENT MILESTONES TO MONITOR FROM BIRTH TO FIRST BIRTHDAY”. Ask/Assess the Questions to Ask/Behaviors to Monitor appropriate to child’s age/corresponding milestone(s). Example: A 5 month old child should meet Questions/Behaviors for Milestones 1-5; may meet for milestone 6. A 10-12 month old child should meet Milestone Questions/Behaviors 1-7. If child does not meet milestone(s), initiate the Next Steps associated with the milestone and re-screen at age appropriate milestone(s) within 45 days.

Hearing/Vision Screening Instrument Instructions: See the Screening Instrument User’s Manual for detailed instructions. See also hearing and vision screening training videos on the Albina web site, Health, Safety, & Nutrition page.
Date of Screening

MonthDayYear
Date
Height:
Weight:
Left
Right
Milestone
Milestone Results
Notes (Optional)
Should be Empty: