Health History Forms
Fill out a HEALTH HISTORY FORM today! Return your completed form to Rolette County Public Health - PO Box 726, Rolla, ND 58367 or email it to shendrickson@nd.gov. Once we receive your completed form we will call and schedule you for an appointment.
What is Health Tracks?
Health Tracks is a preventive health check-up to discuss health concerns and available community resources.
All families enrolled in North Dakota Medical Assistance are strongly encouraged to participate in a Health Tracks screening at least annually. The screening can be used for a Head Start/Preschool Physical.
What is included in a Health Tracks screening?
The Health Tracks Screening is completed by Registered Nurses. The screening consists of a variety of components including resource and referral information:
- Hearing and Vision Evaluations
- Dental Evaluations
- Orthodontic Referrals
- Fluoride Varnish
- Physical Assessment
- Height, Weight, Vital Signs
- Lab Tests
- Hemoglobin
- Urine
- Blood Lead
- Immunizations
- Developmental Screening
- Mental and Behavioral Health Screenings
- Education
- Health
- Nutrition
- Parental Guidance
- Address Concerns/Needs
- Connection to Community Resources and Referrals
Resources
Make an appointment TODAY for a family-friendly screening.
Call the Rolette County Public Health District at (701) 477-5646