Screening Charts | Forms | Letters | Notifications
SCREENING FORMS, CHARTS
HEARING
Hearing Screening Parent/Guardian Notification Results and Referral Form (5/2018)
Classroom Teacher Observations- Hearing (5/2018)
SCOLIOSIS
Scoliosis Screening Parent/Guardian Notification Results and Referral Form(5/2018)
VISION:
Vision Screening Parent/Guardian Notification Results and Referral Form (10/2018)
Note: Parents must be notified of both passing and failing vision results. If a student passes it is sufficient to just indicated passed. However, if they fail you should provide the findings so the follow-up provider has a frame of reference. This form allows you to provide that information.
Classroom Teacher Observation - Vision (5/2018)
Sample Delegation
Sample School Medical Director Delegation Statement- Written delegation is required for review of health examinations, interval health history for athletic, and screening students for vision, hearing, & scoliosis per Education Law, Article 19, section 905,(1). This sample may be customized by the district to comply with that requirement.
Updated 3/2/2021
