School Health Screenings

Name______DOB______Age______Grade______Teacher ______

What Screenings Will Be Done & Who Does Them?

1. Height & Weight School Nurse 2. BMI (Body Mass Index) School Nurse 3. Vision School Nurse 4. Hearing (Grades K, 1, 2, 3, 5, 7) School Nurse & Speech Language Pathologist 5. Head Lice School Nurse 6. Scoliosis (spine curvature) (Grades 6-8) School Nurse 7. Blood Pressure School Nurse 8. Speech/Language Speech/Language Pathologist 9. Screening/Testing to determine students Teachers/Counselors strength

Who is responsible?

School Nurse Responsible for doing the routine health screening and for notifying the parents of the results. Parents (guardians) Responsible for seeing that all follow-up medical/dental work is done for the child. Speech/Language Pathologist Responsible for conducting screenings and notifying parents of any difficulties. When is the screening done?

Throughout the school year.

How will parents be notified?

The school will notify you by a letter sent home with your child if any difficulties are noted. The letter will explain what screenings were done for your child. You will also be told which results are not normal and where to go for further testing.

Does your child have any medical problems?______

What medications does your child take?______

Will any of these medication(s) be taken at school?______

Allergies ______

I hereby give my permission for the above screenings to be done for my child,______(Child’s Name) I also give permission for release of any of the above information for follow-up purposes.

______Parent’s (Guardian’s) Signature Date