The Florida Health Form is a required document for children entering school in Florida. It gathers essential information about a child's medical history and health status, ensuring that any specific needs are addressed before they start their educational journey. Completing this form accurately is crucial for the well-being of your child; please fill it out by clicking the button below.
The Florida Health form is a crucial document for parents and guardians as their children prepare to enter school. This form serves several important functions, beginning with the requirement for a health examination by a qualified professional. Parents are asked to provide detailed medical history in Part I, which includes questions about general health, allergies, and any specific medical conditions or behavioral concerns. Each question must be answered with a simple "yes" or "no," and parents have the opportunity to elaborate on any affirmative responses. This section helps school officials understand the child's health needs better. Part II of the form is dedicated to the medical evaluation, which must be completed by a healthcare provider. It includes vital statistics such as height, weight, and results from various screenings like vision and hearing. Additionally, the form addresses any health conditions that may require special attention during school hours. Recommendations for further evaluations, such as dental and hearing screenings, are also included, emphasizing the importance of proactive health management to support a child's educational journey. Overall, the Florida Health form is designed to ensure that each child's health needs are acknowledged and addressed as they transition into the school environment.
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STATE OF FLORIDA
School Entry Health Exam
To Parent/Guardian: Please complete and sign Part I — Child’s Medical History.
State law for school entry requires a health examination by a legally qualified professional. Additional requirements may be determined by local school districts.
(Please Print)
Name of Child (Last, First, Middle)
Birth Date
Sex
Address (Street)
School
Grade
City and ZIP Code
Home Telephone Number
Parent/Guardian (Last, First, Middle)
PART I — CHILD’S MEDICAL HISTORY
To Parent/Guardian: Please check answers to questions 1 through 8 below in the column on the left. (Please explain any “Yes” answers in the space provided below.)
1.Yes No Any concerns about general health (eating and sleeping habits, weight, etc.)?
2.Yes No Any other specific illness or social/emotional or behavioral problems?
3.Yes No Any allergies (food, insects, medication, etc.)?
4.Yes No Any prescription medication (daily or occasionally)?
5.Yes No Any problems with vision, hearing, or speech (glasses, contacts, ear tubes, hearing aids)?
6.Yes No Any hospitalization, operation, or major illness (specify problem)?
7.Yes No Any significant injury or accident (specify problem)?
8.Yes No Would you like to discuss anything about your child’s health with a school nurse?
To Parent/Guardian: Please explain any “Yes” answers from above.
I am the parent/guardian of the child named above. I give permission for the information on PARTS I and II of this form provided about my child to be reviewed and utilized only by the staff of this school and any school health personnel providing school health services in the district for the limited purpose of meeting my child's health and educational needs.
⌦
Signature of Parent/Guardian
Date
Partnership for School Readiness Recommendations for Prekindergarten and Kindergarten
To Parent/Guardian: Please obtain the services listed below in order to find any problems. Please work with your health care provider to correct or treat any problems that may reduce your child’s ability to learn in school. (These services are recommended but not required.)
1. Comprehensive Vision Examination (3-5 years of age)
Please describe any corrective action for any problems detected and
Date of Exam:
any accommodations required.
Results of Exam:
Health Care Provider:
(check one) Optometrist
Ophthalmologist
2. Comprehensive Dental Examination
Dentist:
3. Hearing Screening
DH3040-CHP-07/2013
School Entry Health Exam Page 2 of 2
PART II — MEDICAL EVALUATION
To be completed and signed by the Health Care Provider ONLY:
The child named above has had a complete history and physical exam on the following date:
(Exam must be within one year of enrollment)
Month
Day
Year
Screening Results:
Height:
Weight:
BMI%:
B/P:
Hct/Hgb:
Lead:
Urinalysis:
Vision - Without Glasses
Right 20/_____
Left 20/_____
Passed
Hearing – Right
Failed
Referred
Vision - With Glasses
Hearing – Left
Gross dental (teeth and gums)
Normal
Abnormal
Refer/Tx:
Head/scalp/skin
Eyes/Ears/Nose/Throat
Chest/Lungs/Heart
Abdomen
Postural assessment
TB risk assessment done
(Please review Targeted Testing Guidelines listed below.)
This child has the following problems that may impact the educational experience:
Vision
Hearing
Speech/Language
Physical
Specify:
Social/Behavioral
Cognitive
This child has a health condition that may require emergency action at school, e.g. seizures, allergies. Specify below.
(This form will be stored in the child’s Cumulative Health Folder and may be accessed by both school and health personnel.)
Recommendations (Attach additional sheet if necessary):
(Please Check One)
This child may participate fully in school activities including physical education.
This child may participate in school activities including physical education with the following restriction/adaptation. (Specify reason and restriction)
Signature/Title of Health Care Provider
Address (Please print or stamp)
___/___/___
Name (Please print or stamp)
Tuberculosis Targeted Testing Guidelines for Health Care Providers
Tuberculosis Infection Risk:
Review the following risks and administer a Mantoux TB skin test if child is in one or more categories. The TB test is administered confidentially as part of the health examination. Do not record administration of any TB test or related information on this form.
•Recent immigrant (< 5 years), frequent visitor to TB endemic areas
•Close contact to active TB case
•Frequent contact with adults at high-risk for disease, HIV+, homeless, incarcerated, illicit drug user
•HIV+ or have other medical conditions that increase the risk to progress from infection to disease, e.g., chronic renal failure, diabetes, hematologic or any other malignancy, weight loss > 10% of ideal body weight, on immunosuppressive medications
Active TB Disease Risk:
•Does the child exhibit signs/symptoms of tuberculosis (e.g. cough for three weeks or longer, weight loss, loss of appetite)?
•If symptoms are present, work-up or refer for TB disease evaluation.
Completing the Florida Health form is essential for ensuring your child's health needs are met upon school entry. This process involves gathering necessary medical information and obtaining a health evaluation from a qualified professional. Follow these steps to accurately fill out the form.
What is the purpose of the Florida Health form?
The Florida Health form is designed to gather essential medical information about a child before they enter school. It is a requirement by state law for a health examination to be conducted by a qualified professional. This form helps ensure that any health concerns are addressed, allowing schools to support the child's educational and health needs effectively.
Who is responsible for completing the Florida Health form?
The parent or guardian of the child is responsible for completing and signing Part I of the Florida Health form. This section includes the child's medical history and any relevant health concerns. It is crucial for parents to provide accurate information to help school health personnel understand and address their child's health requirements.
What kind of medical history information is required on the form?
The form asks for specific details regarding the child's general health, any illnesses or behavioral issues, allergies, medications, vision and hearing problems, hospitalizations, injuries, and whether there is a need for discussion with a school nurse. Parents must check "Yes" or "No" for each question and provide explanations for any "Yes" answers.
What happens after the health examination is completed?
Once the health examination is completed, the health care provider fills out Part II of the form. This includes the results of the physical exam, any health issues that could impact the child's education, and recommendations for participation in school activities. The completed form is then stored in the child's Cumulative Health Folder, accessible to school and health personnel as needed.
Are there any additional health services recommended on the form?
Yes, the form recommends several health services to ensure the child's readiness for school. These include comprehensive vision and dental examinations, as well as hearing screenings. While these services are not mandatory, they are suggested to identify and address any potential issues that may affect the child's ability to learn.
Completing the Florida Health form is a crucial step in ensuring your child’s health needs are met when entering school. However, many parents and guardians make common mistakes that can lead to delays or issues with enrollment. Understanding these mistakes can help ensure that the form is filled out correctly and efficiently.
One frequent mistake is failing to provide complete and accurate information about the child's medical history. Questions regarding general health, allergies, and any previous illnesses must be answered thoroughly. If a parent checks “Yes” for any question, it is essential to provide detailed explanations in the designated space. Neglecting to do so may result in misunderstandings or inadequate support for the child’s health needs.
Another common error involves omitting the signature of the parent or guardian. The form clearly states that the signature is required to authorize the use of the information provided. Without this signature, the form cannot be processed, and the child may face delays in starting school. It is important to double-check that all necessary signatures are included before submitting the form.
Additionally, some individuals overlook the section that requires the health care provider to complete and sign Part II of the form. This section includes vital information such as the results of physical exams and any recommendations for participation in school activities. If this part is left incomplete, the school may not have the necessary information to accommodate the child's needs effectively.
Lastly, parents may forget to keep a copy of the completed form for their records. This oversight can create confusion or difficulties if there are questions or issues later on. Keeping a copy ensures that parents can refer back to the information provided, should the need arise.
By being aware of these common mistakes, parents and guardians can help ensure that the Florida Health form is completed accurately and submitted on time. This proactive approach will support their child's health and educational journey.
The Florida Health form is a vital document for ensuring that children meet health requirements for school entry. Alongside this form, several other documents may be necessary to provide a comprehensive view of a child's health and educational needs. Below is a list of commonly used forms that complement the Florida Health form, each serving a specific purpose in the health evaluation process.
Each of these documents plays a critical role in ensuring that children receive the necessary health evaluations and support for their educational journey. By gathering comprehensive health information, schools can create a safe and supportive environment for all students.
The Florida Health form shares similarities with several other important documents related to health and school entry. Here are five such documents:
When filling out the Florida Health form for your child's school entry, there are several important things to keep in mind. Here’s a helpful list of dos and don’ts to ensure the process goes smoothly.
By following these guidelines, you can help ensure that your child's health information is accurately represented and that they receive the support they need at school.
Misconceptions about the Florida Health form can lead to confusion for parents and guardians. Understanding the facts is crucial for ensuring that children receive the necessary health evaluations for school entry. Here are eight common misconceptions:
Being informed about these misconceptions can help parents navigate the process more effectively, ensuring that their children receive the support they need for a successful school experience.
Here are key takeaways for filling out and using the Florida Health form: