HIPAA Consent to Treat

Required for all students every school year

As a part of Perry Township Schools’ partnership with Community Health Network, a consent to treat must be signed for each student every school year for the child to be seen in the clinic for any reason. This can be completed in Skyward Family Access as a part of the enrollment process, or signed on paper and submitted to your child’s school.

Consent Form – English

Consent Form – Spanish

Consent Form – Chin

Community Health Network’s Privacy Notice