Bracken School-Based Health Services

Hello Bracken County Parents:   

We are happy to kick off the school year at our School-Based Health Center.  The partnership between Bracken County Schools, Bracken County Health Department, Interact for Health, PrimaryPlus and the University of Kentucky College of Dentistry has been a success and we are excited to kick off another HEALTHY SCHOOL YEAR at the PrimaryPlus School-Based Health Center located at 106 Powell St. in Brooksville!

The new on-site center has allowed for increased accessibility with in-person visits for students, staff, and the entire community.  The location offers:

• Family health (in-person on Monday & Thursday) with Bracken County Alumni, Cory Ramsey, PA-C
• Telemedicine visits (which parents are welcome to participate in) will also remain an option for school health as needed.
• Dental services (four days a week) featuring Anna Joines, DMD and Jacqueline Stitt, RHD.

Medical Services:  School-based services are designed to be an added resource to parents and IS NOT designed to replace your child’s pediatrician or routine medical provider.   As a school-based health center, the goal is to provide a convenient, yet quality healthcare evaluation upon parental consent when your child has any minor sickness such as earache, throat infection, eye infection, skin irritation, cold, runny nose, etc.  The Brooksville School-Based Health office is open to students, but also open to the entire community…all ages are welcome to utilize this center.      

Dental Services:  The dental portion of this school-based health center is a collaboration between PrimaryPlus-Dental Center and the University of Kentucky College of Dentistry which will ensure all dental staffing needs are met featuring the care of Dr. Anna Joines, DMD and hygienist Jacqueline Stitt, RDH .  PrimaryPlus-Dental Center is also open for the entire community to utilize (all ages welcome). Dental services include dental exams, cleanings, x-ray and some restorative procedures.

Consent Information:  Attached are the consent forms for 2025-2026 school-based services.  Parents/guardians may select which services they would like their child to participate. Note: If the student is already a patient of PrimaryPlus, they will STILL need to complete the forms because school-based services require added information and must be completed once a year—so last year’s consent forms are no longer valid.  

Consent packets will need to be completed and returned by Friday September 5th.

Students that return completed packets (via paper form OR digitally) will have an opportunity to WIN 1 of 3
$100 gift cards provided by PrimaryPlus.

This partnership is geared towards ensuring happy, healthy kids and creating access to quality care for families of the region!  You can find a list of frequently asked questions regarding school-based health and the PrimaryPlus Notice of Privacy and HIPAA Practices on the school website or at www.primaryplus.net.    

Many Well Wishes for a Great School Year,  

The PrimaryPlus Team   

 

Service Consent

Please read carefully, COMPLETE FORM, SIGN, and DATE.  Please notify PrimaryPlus if there are any changes in health information or guardianship. PrimaryPlus collects new consents each school year. If your child is already a patient of PrimaryPlus and you wish to participate in school-based health services, forms must be completed.

Consent packets are for school-based Primary Care & Dental services ONLY. Counseling Services are referral based OR a parent/guardian can call to schedule for this service.

Please sign below.

Note that if the parents of the above stated child have joint custody, signatures of both parents are required for consent to treat, please be sure to sign below.

Patient/Student Signature is ONLY allowed if 18 or OLDER. If under 18, MUST be signed by parent/guardian.

PrimaryPlus shall provide a copy of its Notice of Privacy and HIPAA Practices upon my request, which is also available at www.primaryplus.net.

PrimaryPlus School-Based Health Registration Form

Patient Information

Please Complete the following information about your child.

Parent/Guardian Information:

Parent/Guardian #1

Parent/Guardian #2 (if applicable)

Emergency Contact (Other than Guardian)

*PrimaryPlus is happy to share records of your child's visit with their pediatrician or regular primary care provider.

I have reviewed the health history form provided by PrimaryPlus and have disclosed all my child's known health history to date. PrimaryPlus asks that you alert us if anything regarding your child's health should change throughout the year.

I, _________ (parent/guardian) acting on behalf of ________ (student/patient) who is suffering from a condition requiring medical, podiatric and/or dental care.

I agree to allow this care to be received. It may include routine diagnostic and medical treatment that the attending physician(s) or others of the health center medical staff consider necessary. Services could include treatment for illness or injury including over the counter medications or necessary prescriptions, well child exams, appropriate immunizations, and appropriate behavioral evaluations--unless emergency services are needed.

2. I understand that the practice of medicine and surgery is not an exact science, and that diagnosis and treatment may involve risks of injury or even death. I acknowledge that no guarantees have been made to me about the result of examination or treatment in this

3. I understand that:

a) Normally, except under emergency or extraordinary circumstances, no important procedures are performed upon a patient unless and until he or she has had an opportunity to discuss them with the physician or other health professionals to the patient's satisfaction.

b) Each patient has the right to agree or refuse to agree to any proposed procedure or therapeutic course; and

c) No patient will be involved in any research or experimental procedure without his or her full knowledge and agreement.

4. I realize that there are medical, nursing and other health care personnel at this health center who are still in training. I understand that they may be present during my care unless I request them not to be present.

5. This form has been fully explained to me, and I am satisfied, and I understand its content and significance.

6. Once the student's completed consent and history are received, PrimaryPlus can begin caring for your child for approved services during school hours. Attempts will be made to notify the parent/guardian of your child's appointment and to see if they wish to attend the visit. If no contact is made and all consents are in place, PrimaryPlus will continue the appointment as needed and contact the parent with follow-up information following the appointment including sending home a copy of the care summary.

Note: Patient/Student Signature is ONLY allowed if 18 or OLDER

I HEREBY CONSENT FOR THE FOLLOWING PERSON/PERSONS TO BRING MY UNDERAGED CHILD TO LEWIS COUNTY PRIMARY CARE CENTER, INC. dba PRIMARYPLUS FOR TREATMENT.

(Please list name and relationship to child)