initial office visit means what

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At first a preventive visit and office visit may seem similar, but there is a difference. Knowing which to schedule can help ease any confusion.

You schedule preventive visits which are annual physicals, well child exams and wellness exams to help prevent or detect any health concerns. This is also known as your annual wellness exam or annual health maintenance exam. Confusion comes when at your annual checkup you want to discuss or receive treatment for a new or existing condition that requires action. This is where a preventive visit can become an office visit and your bill can be impacted.

You schedule an office visit, or problem-related service, for problem focused care, meaning you notice symptoms and want to talk with your provider. In your preventive visit if a problem is addressed and needs to be treated, your provider’s office is required to bill as a separate office visit, due to action for treatment needed.

What is a preventive visit?

• Complete physical exam (annual health maintenance exam)
• Blood pressure, blood glucose and cholesterol screening tests
• Pelvic exams, pap smear
• Prostate and colorectal cancer screenings
• Sexually transmitted infection testing
• Thorough review of medical history, general health and well-being
• Vaccination review and update
• Developmental screenings
• Evaluation of future risks

What is an office visit?

• Diagnosing and monitoring specific medical conditions
• Addressing medical concerns and treatment plans
• Post hospitalization discharge care
• Medication refills
• Specialist referrals
• Testing/lab results
• Addressing new or worsening symptoms
• Depending on benefits an office visit can result in additional costs

Before scheduling an appointment state clearly whether this will be a wellness exam or if this appointment will be to discuss and treat new health concerns or symptoms. If a wellness exam is spent on specific or new health issues and treated it will no longer be considered a preventive visit, and it will be billed as an office visit.

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What is a Preventive Visit vs. an Office Visit?

When scheduling a doctor’s appointment, you may think: what type of medical appointment will insurance charge this as? 

Knowing the difference between a preventive visit and an office visit can be confusing, especially if you schedule a preventive visit and end up receiving treatment for a certain health issue, like blood pressure concerns or frequent headaches. Learn why Jenna Kemp, MD , UnityPoint Health says regardless of the type of appointment, you’ll receive the same personalized experience.

Preventive Visit: Staying Well

A medical preventive visit is a yearly doctor's appointment intended to prevent illnesses and detect health concerns early, before symptoms are noticeable. Preventive visits could be an annual physical, well-child exam, Medicare wellness exam or welcome to Medicare visit. Most insurance companies are required to cover preventive care services at no cost to patients. During your appointment, you’ll review your overall health and well-being. Depending on your age, services may include:

• Complete physical exam
• Immunization review and update
• Age-appropriate heart disease screenings (blood pressure, blood glucose and cholesterol tests)
• Cancer risk screenings (pelvic exam, Pap smear, prostate and colorectal screenings)
• Sexually-transmitted disease testing
• Evaluation for signs of depression
• Alcohol, depression, obesity and tobacco counseling

“Each visit is unique, and there isn’t a standard lab panel or order set that everyone will automatically need,” Dr. Kemp says. “Preventive visits are an opportunity to discuss care areas, plans from other specialists and share lifestyle modifications to establish a long-term health plan. We work as a team with our patients to build trust and help align their health goals.”

Office Visit: Getting Well

An office visit is designed to discuss new or existing health issues, concerns, worries or symptoms. Your provider may order tests, prescribe medication, refer you to a specialist or provide advice and education. Office visits are covered by a standard insurance co-pay or deductible. “We take care of people as individuals. The care involved even for the same problem is often very different. It’s not unusual for two appointments to be on the schedule for ‘headache,’ and one will be a migraine episode, while the other is related to underlying depression and insomnia. We allot the necessary amount of time to come up with a treatment plan specific to each person’s case,” Dr. Kemp says.

Keep Your Health on Point

We care about people most, it’s why we do what we do. Dr. Kemp says her, and her team’s, main goal is to establish meaningful relationships with patients. “We have so many excellent primary care providers who truly care about their patients and work with them to be as healthy as possible. Our goal is always for patients to be respected and guided in their health through evidenced-based medical information. If you don’t feel like you’re heard or valued by your doctor, let them know!”

How to Schedule a Doctor's Appointment

To establish care with a new provider or to schedule an appointment with your current provider you can: 

• Find a Location and call to schedule
• Find a Doctor and either call to schedule or schedule an appointment online, if available 
• Log into the MyUnityPoint patient portal  to schedule an appointment with your doctor online
• Office Visit – Brief
• Office Visit – Extended
• Virtual Visit
• Well Child Visit
• Physical Visit

Choose this visit type if you have multiple or more complex health concerns to talk to your providers about, such as abdominal pain, multiple medication management and/or depression/anxiety.

 This visit type is only available for existing patients. Selecting this option does not schedule a virtual visit, but sends a request to be seen virtually to your primary care provider. Please note: not all providers offer virtual visits. For same-day virtual care options, select Virtual Urgent Care or E-Visit – SmartExam on the main menu.

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What is the difference between a physical and an office visit?

Preventive care (Annual Physicals, Well Child Exams, and Wellness Exams) are services to catch health problems early. Usually, these preventative services are covered by your insurance company with little to no out of pocket cost to you. The distinction between a “physical” and an “office visit” is especially important when we submit a bill to your insurance company for that visit. However, understanding what your insurance will cover at your preventative visit creates some confusion for many of our patients. Therefore, here are some clarifications:

What is preventative care?

A “physical” or “preventive health exam” is a thorough review of your general well-being. The doctor will review your medical problems, perform a complete physical examination and make recommendations concerning your health. This may include general recommendations regarding diet and exercise, age appropriate immunizations and cancer screening exams.

What is an office visit?

An “office visit” is an appointment time to discuss new or existing problems. The questions and exam will focus on the problems discussed. This is different from preventative care. Hence, if you schedule a physical but your appointment is spent on specific health issues or problem(s), we can no longer bill this as a physical, but instead, as a problem-focused “office visit”. Please do not ask your provider to change your office visit to a physical, change your diagnosis, and/or change the billing amount to your insurance company. This is considered “fraudulent” billing behavior by your insurance company and federal regulatory agencies. Meaning, what we bill to your insurance company for payment must be consistent with the visit notes and exam.

Some common preventative care services include:

• Cholesterol screening
• Colon cancer screening
• Diabetes screening
• Review of past history (surgical, family, social)
• Immunizations
• Routine physical exam
• Fall risk screening
• Depression screening
• Dementia screening
• Alcohol screening
• End of life planning and DNR’s
• Contraceptive and family planning/counseling
• Contraceptive devices and contraceptive drugs

Additional Services for Women

• Breastfeeding support, supplies, counseling
• Prenatal care
• Antepartum care
• Routine mammograms
• Routine Pap tests

For Children

• Newborn hearing screening
• Periodic well-child visits
• Sexually transmitted infection (STI) screening and prevention counseling for adolescents
• Vision screening

What to expect at your primary care visit

Visiting your primary care provider is now virtual or in-person

Health care is changing, and there are new, convenient ways to manage your health. From virtual visits and health management apps to going to a traditional appointment, health care providers and resources are more accessible than ever.

To serve you better, OSF HealthCare now offers more ways for you to manage your health. As a patient, you now have more options for in-person and virtual urgent care options for minor injuries and illnesses, virtual primary care options and better access for the traditional face-to-face office visit.

Mark Meeker, DO , an internal medicine physician with OSF HealthCare, talks about how these changes can affect your health care journey.

“With an eye on safety and convenience, health care clinicians are providing different and convenient ways for you to manage your health and connect with your physician or advanced practice provider,” Dr. Meeker said. “We want to conveniently increase the touch points between patients and their care teams to enhance the quality of care they receive.”

Whether you choose a virtual or office visit, you’re able to discuss a variety of topics, including:

• Chronic illness management
• Coordinating care with other specialists
• Lab results
• Lifestyle changes
• Medication renewals or changes
• Mental health
• New physical issues or concerns
• Recommendations for health screenings

The trade-off to a virtual visit is the lack of in-person interaction. Being in the same room allows your primary care provider (PCP) to get a sense of your overall well-being and do a hands-on physical examination.

However, if you haven’t experienced any new symptoms or have any concerns, a virtual visit is a safe and convenient alternative to meet your overall health goals, Dr. Meeker said. But it doesn’t completely replace the need for an office visit.

Virtual visits

Meet with your PCP via a smartphone, tablet or computer.

The first step is to start or sign in to your OSF MyChart account. You will go through a registration process where you will need to enter your personal and insurance information. You may be required to take a picture of certain documents, ID and insurance card, and upload them to your account, so have this information available.

A nurse or assistant will then do a basic health assessment before your clinician joins the video call.

Your PCP will still be able to order lab tests, refill prescriptions and determine if you need to come to the office for a physical examination.

“Virtual visits allow an open line of communication while avoiding unnecessary risks,” Dr. Meeker said, acknowledging that they’re also a great solution when a trip to the office is not convenient.

Office visits

The traditional health care route will never be replaced. Seeing your provider in-person is essential for good health.

“With a face-to-face office visit, I can examine your heart, ears, head and neck, lungs, stomach and throat to see if you have any pain or trouble in those areas,” Dr. Meeker said. “In-person visits also allow us to take an accurate body mass index, heart rate and blood pressure readings. Often, with something like high blood pressure, there are no signs or symptoms.

“Acute and chronic illnesses can also lead to physical exam findings that influence our treatment plans, and those have to be looked for and monitored on an episodic basis.”

Don’t forget to bring a valid photo ID, insurance card, medical history and a list of your medications.

No matter which type of visit you choose, be an active participant . Prepare a list of questions and concerns to discuss with your provider. Your primary care provider is a long-term partner in your health management, so it’s crucial to work with a provider who is right for you and your family and the methods for receiving care.

To learn tips for talking to your primary care provider, click here .

Last Updated: April 1, 2022

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• / Office Visit or Consultation? Here’s How to Make the Call

Office Visit or Consultation? Here’s How to Make the Call

• Mark Complete

This article is from June 2006 and may contain outdated material.

When can you code for a consultation? According to the latest CMS guidance, Medicare won’t pay for a reasonable and medically necessary consultation unless you meet these three requirements:

• The service is provided by a physician or qualified nonphysician practitioner (NPP) 1 whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. This requirement distinguishes a consultation service from other E&M visits.
• The consultant documents both a request for a consultation from an appropriate source and the need for consultation (i.e., the reason for the service) in the patient’s medical record. This also must appear in the requesting physician’s or qualified NPP’s plan of care, which is in the patient’s medical record.
• The consultant provides a written report of his or her findings and recommendations, which shall be provided to the referring physician. If, say, a large multispecialty group practice uses a shared medical record, it would be enough to include the consultant’s report in the medical record documentation rather than requiring a separate letter from the consultant. Those findings and recommendations should be available in the consultation report.

What expertise is required? The intent of a consultation is that a referring professional is asking the consultant for help (e.g., an opinion or direction) in evaluating or treating a patient because that consultant has expertise in a specific medical area beyond the requesting professional’s knowledge.

Will you get paid for intraoffice consultations? Provided that the expertise requirement is met, Medicare will pay for a consultation even when the requesting professional and the consultant are both in the same group practice. However, a consultation service shall not be reported on every patient as a routine practice between physicians and qualified NPPs within a group practice setting.

When can care be initiated? A physician or qualified NPP may initiate diagnostic services and treatment at the initial consultation service.

Definitely Not a Consult

The following do not meet the criteria for consultation services: Standing orders in the medical record; no order for a consultation; and no written report of a consultation.

Transfer of care. When a physician or qualified NPP asks another physician or qualified NPP to take over responsibility for managing the patient’s complete care, it is considered a transfer of care. Coding should be for the appropriate level of new or established E&M code or Eye Code, but not a consultation code.

CMS provides this example. An ER physician treats a patient for a sprained ankle. The patient is discharged and told to visit the orthopedic clinic for follow-up. Since the ER physician doesn’t need any advice or opinion from the clinic’s physician, the clinic can’t report a consultation service but should report the appropriate office or other outpatient visit code instead.

_________________________________

1 Medicare defines an NPP as “any nonphysician licensed medical professional.” It includes in this definition providers such as physician assistants, nurse practitioners and clinical nurse specialists, as well as social workers, physical therapists and speech therapists.

For the latest coding updates, visit www.aao.org/aaoe .

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Office/Outpatient E/M Codes

2021 e/m office/outpatient visit cpt codes.

The tables below highlight the changes to the office/outpatient E/M code descriptors effective in 2021.

More details about these office/outpatient E/M changes can be found at CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes.

All specific references to CPT codes and descriptions are © 2023 American Medical Association. All rights reserved. CPT and CodeManager are registered trademarks of the American Medical Association.

Download the Office E/M Coding Changes Guide (PDF)

Example sentences office visit

To find your nearest office visit citizensadvice.org.

He charges $225 for a 40-minute physical examination and $150 for a 20-minute office visit .

Most ureteral stents can be removed cystoscopically during an office visit under topical anesthesia after resolution of the urolithiasis.

Removal of the external frame and bolts usually requires special wrenches and can be done with no anesthesia in an office visit .

With staff out of the office visiting journalists and clients, it became clear that they needed at least mobile e-mail.

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Definition of 'visit' visit

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Initial office visit

What does "Initial office visit" mean in a report or doctor's letter? In our medical dictionary, you will find a patient-friendly explanation of the meaning of this medical term.

Explanation

"Initial office visit" refers to the first time a patient sees a doctor or other healthcare professional at their office. This visit usually involves a comprehensive health examination and discussion about the patient's medical history. The purpose is to assess the patient's current health status and identify any potential health issues. This term is commonly used in medical billing and insurance to denote the first appointment a patient has with a healthcare provider.

Univ. Prof. Dr. med. Lukas A. Huber

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BaluMed makes medicine understandable! Our extensive medical report explanation 'translates' complex medical terms from MRI findings and discharge summaries into easily understandable language. With a combination of artificial intelligence and medical expertise, we offer quickly available and reliable information.

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What drives the level of office visit codes?

Many physicians and coders think longer documentation means charging higher level visits. Fortunately, that is not always the case. You can document less as long as you are documenting the correct and necessary information.

Medical decision making drives the level of office visit

The medical decision-making portion of evaluation and management guidelines is what ultimately determines the level billed. Higher complexity in decision making justifies higher levels.

Evaluation and Management visits have three main components:

• Physical exam
• Medical decision making.

For established patients, guidelines state that only two of these three need to be met for a given level. The Center for Medicare and Medicaid Services advises to let medical decision making drive the visit.

What does “Medical decision making should drive the visit” really mean?

This is such a grey area in the guidelines that it is causing practices to over-bill or undercharge, which will ultimately cause them to fail an audit.

CMS stated, “It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed.” ( Medicare Claims Processing Manual 30.6.1)

Many practices are so confused about what this means, that they just pick the middle level and call it a day. Those practices need clarification and education on how to get to the correct level for the service performed. MEREM can help!

Below are some examples to remember when choosing the level of an office visit to the bill.

• If the provider is seeing an established patient who is coming in for a recheck,  ask yourself is the patient’s diagnosis improving or worsening?

– If the problem is improving, the level of service will likely be a level 2 (99212).

⁃ If the problem is worsening, the level of service is likely a level 3 (99213).

• For established patients coming in with a new problem , these level of service is likely a level 3 (99213) or level 4 (99214). The final level for this patient will depend on the diagnosis and treatment performed during the service.
• Code 99215 is used to report High MDM. 99215 is reserved for those patients who require extensive workup regarding Chronic Illnesses with severe exasperations or acute illness or injuries that threaten loss of life or bodily function. Management options for these patients may include IV drug therapy, Emergency Surgery or a DNR status because of poor prognosis.

Let MEREM Health help you conquer the challenges of coding your office visits. Call us to get a free quote at 205-329-7519.

© 2024 MEREM Health. All Rights Reserved.

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General Election 2024: What happens now an election has been called?

What is the dissolution of parliament? How does it happen? Are there any MPs during a campaign? What happens on polling day?

Political reporter @alixculbertson

Thursday 23 May 2024 11:08, UK

Rishi Sunak has called a general election for this summer.

The prime minister has been saying for months he would call a vote for the "second half of the year", and it will now be held on Thursday, 4 July.

Under the Dissolution and Calling of Parliament Act 2022, Mr Sunak had until 17 December this year to call an election - as votes must be held no more than five years apart.

Sky News looks at what happens now.

General election latest: Rishi Sunak to call election for 4 July

Requesting permission to dissolve parliament

The prime minister has already requested permission from the King to hold a general election, as the power to dissolve parliament - end the session - legally lies with him.

More on General Election 2024

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Parliament must be "dissolved" for an election to officially take place. Polling day then takes place 25 working days after that date.

Mr Sunak said in a speech outside Downing Street on Wednesday that the King had granted his request to dissolve parliament.

As a result, parliament will be prorogued on Friday, 24 May, while dissolution will take place on Thursday, 30 May.

What happens in parliament after an election is called?

There is usually a period of several days, known as "wash-up", between an election being called and the dissolution of parliament.

During "wash-up", parliament will continue as normal, but any parliamentary business not completed by the end of that time will not enter into law and cannot be continued into the next parliament.

Keep up with all the latest news from the UK and around the world by following Sky News

This normally leads to a rush to pass legislation through parliament to get it onto the statute book, which often means parties having to work together to agree on which bills they will support.

The longest "wash-up" period since 1992 was in 2017 when parliament sat for a further seven days after the election was called, according to Institute for Government (IfG) analysis.

What happens after parliament is dissolved?

Once parliament is dissolved, there are no longer any MPs as every seat in the House of Commons becomes vacant.

House of Lords members retain their positions, but no more business happens until the next parliament begins.

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Government ministers remain in post until a new government is formed.

However, government activity is restricted during the campaign period to ensure public money is not used to support the campaign of the party in power and to maintain civil service impartiality.

Restrictions normally begin when parliament has been dissolved, however, they can start before this, as they did in 2017.

The campaign

Campaigning never stops for political parties, but it will ramp up after an election is announced.

Parties, their candidates, and supporters, will promote their policies during the campaign period by publishing informative material, knocking on doors to talk to people, writing newspaper articles, and supporters putting posters in their windows or placards in their front gardens.

There is no set time for when manifestos explaining the parties' pledges have to be launched, but they generally happen within a few days of each other.

Since 1997, Labour and Conservative manifestos have been launched between 18 and 29 days before the election, the IfG found.

Televised debates between party leaders or other politicians became a feature of campaigns in 2010.

Their timing and format are negotiated between political parties and broadcasters, but there is no obligation for any of them to take part.

Polling day

Registered voters can submit postal votes before the day, but most people go to polling stations, which are open from 7am until 10pm.

This will be the first general election where photographic ID will be required to vote.

When voting closes, an exit poll is announced following a survey of voters taken from about 150 constituencies in England, Scotland and Wales.

What happens after the election?

If the current government retains a majority in the new Parliament after an election, it will continue in office and resume normal business.

If the election results in a clear majority for a different party, the incumbent prime minister and government will immediately resign, and the King will invite the leader of the party that has won the election to form a government.

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It becomes slightly more complicated if the result is a hung parliament.

The current government remains in office unless and until the prime minister tenders his and the government's resignation to the King.

The government is entitled to await the meeting of the new parliament to see if it can command the confidence of the House of Commons or to resign if it becomes clear that it is unlikely to command that confidence.

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They could also be forced to resign if they lose a vote of no confidence, at which point, the person who appears to be most likely to command the confidence of the House of Commons will be asked by the Monarch to form a government.

In terms of dates, the new Parliament will be summoned to meet on Tuesday, 9 July, when the first business will be the election of the speaker and the swearing-in of members.

The state opening of Parliament will be on Wednesday, 17 July.

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Blog The Education Hub

https://educationhub.blog.gov.uk/2024/05/16/new-rshe-guidance-what-it-means-for-sex-education-lessons-in-schools/

New RSHE guidance: What it means for sex education lessons in schools

R elationships, Sex and Health Education (RSHE) is a subject taught at both primary and secondary school.  

In 2020, Relationships and Sex Education was made compulsory for all secondary school pupils in England and Health Education compulsory for all pupils in state-funded schools.  

Last year, the Prime Minister and Education Secretary brought forward the first review of the curriculum following reports of pupils being taught inappropriate content in RSHE in some schools.  

The review was informed by the advice of an independent panel of experts. The results of the review and updated guidance for consultation has now been published.   

We are now asking for views from parents, schools and others before the guidance is finalised. You can find the consultation here .   

What is new in the updated curriculum?  

Following the panel’s advice, w e’re introducing age limits, to ensure children aren’t being taught about sensitive and complex subjects before they are ready to fully understand them.    

We are also making clear that the concept of gender identity – the sense a person may have of their own gender, whether male, female or a number of other categories   – is highly contested and should not be taught. This is in line with the cautious approach taken in our gu idance on gender questioning children.  

Along with other factors, teaching this theory in the classroom could prompt some children to start to question their gender when they may not have done so otherwise, and is a complex theory for children to understand.   

The facts about biological sex and gender reassignment will still be taught.  

The guidance for schools also contains a new section on transparency with parents, making it absolutely clear that parents have a legal right to know what their children are being taught in RSHE and can request to see teaching materials.   

In addition, we’re seeking views on adding several new subjects to the curriculum, and more detail on others. These include:   

• Suicide prevention  
• Sexual harassment and sexual violence  
• L oneliness  
• The prevalence of 'deepfakes’  
• Healthy behaviours during pregnancy, as well as miscarriage  
• Illegal online behaviours including drug and knife supply  
• The dangers of vaping   
• Menstrual and gynaecological health including endometriosis, polycystic ovary syndrome (PCOS) and heavy menstrual bleeding.  

What are the age limits?   

In primary school, we’ve set out that subjects such as the risks about online gaming, social media and scams should not be taught before year 3.   

Puberty shouldn’t be taught before year 4, whilst sex education shouldn’t be taught before year 5, in line with what pupils learn about conception and birth as part of the national curriculum for science.  

In secondary school, issues regarding sexual harassment shouldn’t be taught before year 7, direct references to suicide before year 8 and any explicit discussion of sexual activity before year 9.  

Do schools have to follow the guidance?  

Following the consultation, the guidance will be statutory, which means schools must follow it unless there are exceptional circumstances.   

There is some flexibility w ithin the age ratings, as schools will sometimes need to respond to questions from pupils about age-restricted content, if they come up earlier within their school community.   

In these circumstances, schools are instructed to make sure that teaching is limited to the essential facts without going into unnecessary details, and parents should be informed.  

When will schools start teaching this?  

School s will be able to use the guidance as soon as we publish the final version later this year.   

However, schools will need time to make changes to their curriculum, so we will allow an implementation period before the guidance comes into force.     

What can parents do with these resources once they have been shared?

This guidance has openness with parents at its heart. Parents are not able to veto curriculum content, but they should be able to see what their children are being taught, which gives them the opportunity to raise issues or concerns through the school’s own processes, if they want to.

Parents can also share copyrighted materials they have received from their school more widely under certain circumstances.

If they are not able to understand materials without assistance, parents can share the materials with translators to help them understand the content, on the basis that the material is not shared further.

Copyrighted material can also be shared under the law for so-called ‘fair dealing’ - for the purposes of quotation, criticism or review, which could include sharing for the purpose of making a complaint about the material.

This could consist of sharing with friends, families, faith leaders, lawyers, school organisations, governing bodies and trustees, local authorities, Ofsted and the media.  In each case, the sharing of the material must be proportionate and accompanied by an acknowledgment of the author and its ownership.

Under the same principle, parents can also share relevant extracts of materials with the general public, but except in cases where the material is very small, it is unlikely that it would be lawful to share the entirety of the material.

These principles would apply to any material which is being made available for teaching in schools, even if that material was provided subject to confidentiality restrictions.

Do all children have to learn RSHE?  

Parents still have the right to withdraw their child from sex education, but not from the essential content covered in relationships educatio n.  

You may also be interested in:

• Education Secretary's letter to parents: You have the right to see RSHE lesson material
• Sex education: What is RSHE and can parents access curriculum materials?
• What do children and young people learn in relationship, sex and health education

Tags: age ratings , Gender , Relationships and Sex Education , RSHE , sex ed , Sex education

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