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Outline

The Florida Health form is an essential document for parents and guardians as their children prepare to enter school. This form is designed to collect vital information regarding a child's medical history, ensuring that schools can adequately address their health needs. Parents must complete Part I, which includes questions about general health, allergies, and any existing medical conditions that may affect the child's learning experience. Additionally, it provides space to elaborate on any "Yes" answers, allowing for a comprehensive understanding of the child's health status. Part II requires a licensed health care provider to conduct a thorough medical evaluation, including a physical exam and screenings for vision, hearing, and other health indicators. This section also highlights any health conditions that may necessitate special accommodations at school. Furthermore, the form emphasizes the importance of follow-up services, such as dental and vision examinations, to support the child's overall well-being and readiness for school. By completing this form, parents play a crucial role in fostering a safe and supportive educational environment for their children.

Sample - Florida Health Form

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)
Date of Exam:
Results of Exam:
Health Care Provider:
(check one) Optometrist Ophthalmologist
Please describe any corrective action for any problems detected and
any accommodations required.
2. Comprehensive Dental Examination
Date of Exam:
Results of Exam:
Dentist:
Please describe any corrective action for any problems detected and
any accommodations required.
3. Hearing Screening
Date of Exam:
Results of Exam:
Health Care Provider:
Please describe any corrective action for any problems detected and
any accommodations required.
Page 1 of 2
DH3040-CHP-07/2013
School Entry Health Exam
Page 2 of 2
Name of Child (Last, First, Middle) Birth Date
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:
DH3040-CHP-07/2013
Vision - Without Glasses
Right 20/_____ Left 20/_____
Hearing – Right Passed Failed Referred
Passed
Failed
Right 20/_____ Left 20/_____
Vision - With Glasses
Referred
Hearing – Left Passed Failed Referred
Gross dental (teeth and gums) Normal Abnormal Refer/Tx:
Head/scalp/skin
Normal Abnormal Refer/Tx:
Eyes/Ears/Nose/Throat Normal Abnormal Refer/Tx:
Chest/Lungs/Heart Normal Abnormal Refer/Tx:
Abdomen Normal Abnormal Refer/Tx:
Postural assessment Normal Abnormal Refer/Tx:
(Please review Targeted Testing Guidelines listed below.)
TB risk assessment done
This child has the following problems that may impact the educational experience:
Vision Hearing Speech/Language Physical Social/Behavioral Cognitive
Specify:
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 Date 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.

Form Information

Fact Name Description
Purpose of the Form This form is required for school entry in Florida. It collects important health information about the child to ensure their well-being and ability to learn.
Legal Requirement Florida law mandates that a health examination be conducted by a qualified professional before a child can enter school.
Parental Consent Parents or guardians must sign the form, granting permission for the school staff to use the health information provided for educational needs.
Additional Recommendations The form suggests obtaining additional health services, such as vision and dental exams, to address any potential issues affecting the child's learning.

Detailed Guide for Filling Out Florida Health

Completing the Florida Health form is an essential step for ensuring your child’s health needs are documented for school entry. This process involves gathering important medical information and having a qualified health care provider complete a medical evaluation. Follow these steps carefully to fill out the form accurately.

  1. Gather Necessary Information: Collect your child's personal details, including their full name, birth date, sex, address, and school grade.
  2. Complete Part I - Child’s Medical History: Answer questions 1 through 8 by checking “Yes” or “No” in the designated column. If you answer “Yes” to any question, provide explanations in the space provided.
  3. Sign the Form: As the parent or guardian, sign and date the form to give permission for the information to be reviewed by school staff.
  4. Obtain Recommendations: If applicable, seek the recommended health services such as vision, dental, and hearing examinations. Record the dates and results of these exams on the form.
  5. Schedule a Medical Evaluation: Arrange for a qualified health care provider to conduct a complete history and physical exam of your child. Ensure the exam date is within one year of enrollment.
  6. Complete Part II - Medical Evaluation: Have the health care provider fill out this section, including screening results and any recommendations.
  7. Review and Submit: Double-check all the information for accuracy before submitting the completed form to the school.

Obtain Answers on Florida Health

  1. What is the purpose of the Florida Health form?

    The Florida Health form is required for school entry and ensures that children receive a comprehensive health examination by a qualified professional. This form collects important medical history and current health information to help school staff support the child's health and educational needs.

  2. Who needs to fill out the form?

    The form must be completed by the child's parent or guardian. It is crucial that they provide accurate information about the child's medical history, including any health concerns, allergies, or medications.

  3. What information is required in Part I of the form?

    Part I includes questions regarding the child's general health, specific illnesses, allergies, medications, and any issues related to vision, hearing, or speech. Parents should check “Yes” or “No” for each question and provide explanations for any “Yes” answers.

  4. What should I do if my child has a medical condition?

    If your child has a health condition that may require special attention at school, you must specify this in the form. This includes conditions like allergies or seizures. The information will be stored in the child’s Cumulative Health Folder and will be accessible to school and health personnel.

  5. Are there any additional health services recommended?

    Yes, the form recommends several services, such as a comprehensive vision examination, dental examination, and hearing screening. While these services are not mandatory, they are encouraged to help identify any issues that could affect your child's learning.

  6. What happens in Part II of the form?

    Part II must be completed by a health care provider. This section includes a complete history and physical exam, along with screening results like height, weight, and vision. The provider will also indicate any health conditions that could impact the child’s educational experience.

  7. How is the information on the form used?

    The information provided on the Florida Health form is used solely for the purpose of meeting the child's health and educational needs. School staff and health personnel will review the data to ensure appropriate support and accommodations are in place for the child.

Common mistakes

When filling out the Florida Health form, many parents and guardians make common mistakes that can lead to delays or complications. One frequent error is failing to provide complete information in the child's medical history. Each question in Part I requires careful consideration. If a parent checks "Yes" for any health concerns, they must provide detailed explanations. Omitting this information can hinder the school’s ability to support the child's health needs.

Another mistake involves incorrect or incomplete contact information. The form requires accurate details such as the child's name, address, and parent/guardian contact numbers. If any of these fields are left blank or filled out incorrectly, it can create challenges in communication between the school and the family, especially in emergencies.

Parents also often overlook the importance of having the health care provider complete Part II of the form. This section is crucial as it includes the child's physical examination results and any health conditions that may affect their school experience. If this part is missing or improperly filled out, the school may not have the necessary information to ensure the child's safety and well-being.

Additionally, many individuals neglect to check for updates on local school district requirements. While the state mandates certain health examinations, local districts may have additional criteria. Failing to comply with these can result in the child being unable to enroll or participate in school activities.

Finally, parents sometimes forget to sign and date the form. A signature is required to authorize the use of the health information provided. Without it, the form is incomplete and may not be accepted by the school. Each of these mistakes can lead to significant delays in processing the health form, ultimately affecting the child’s school entry and health services.

Documents used along the form

When completing the Florida Health form for school entry, several additional documents may be necessary to ensure a comprehensive understanding of your child's health needs. Below are some commonly used forms that complement the Florida Health form.

  • Immunization Records: This document provides a detailed account of your child's vaccinations. It is crucial for verifying that all required immunizations are up to date before school enrollment.
  • Physical Examination Report: This report, typically completed by a healthcare provider, outlines the results of a recent physical exam. It confirms that your child is fit for school activities and identifies any health concerns.
  • Emergency Contact Form: This form lists individuals who can be contacted in case of an emergency. It is essential for the school to have up-to-date contact information for quick access.
  • Medication Administration Form: If your child requires medication during school hours, this form must be completed by a parent or guardian and a healthcare provider. It outlines the medication, dosage, and administration schedule.
  • Special Education Evaluation Form: If your child has special educational needs, this form documents the results of evaluations conducted by educational professionals. It helps the school develop appropriate support plans.
  • Consent for Release of Information: This document allows healthcare providers to share your child's health information with school personnel. It is vital for coordinated care and support.

Having these documents ready can facilitate a smoother enrollment process and help ensure that your child's health and educational needs are adequately addressed. It is always advisable to consult with your healthcare provider or school nurse if you have any questions regarding these forms.

Similar forms

  • Child's Health Assessment Form: Similar to the Florida Health form, this document collects comprehensive health information about a child, including medical history and current health status. It is often required for school enrollment.
  • Immunization Records: Like the Florida Health form, immunization records document a child's vaccinations. Both are essential for ensuring that children meet health requirements for school attendance.
  • Physical Examination Form: This form provides details about a child's physical health, including height, weight, and any medical conditions. It parallels the Florida Health form in its purpose of assessing a child's readiness for school.
  • Emergency Contact Form: While primarily focused on emergency contacts, this document often includes health information similar to the Florida Health form. Both aim to ensure that a child’s health needs are addressed promptly in emergencies.
  • Special Education Evaluation Form: This document assesses a child's educational needs, including health-related concerns. It shares similarities with the Florida Health form in identifying potential barriers to learning.
  • Health Insurance Information Form: This form collects information about a child's health insurance coverage, which can be relevant for accessing health services. It complements the Florida Health form by ensuring that health care needs are financially supported.
  • Nutrition Assessment Form: Like the Florida Health form, this document evaluates dietary habits and nutritional needs. Both forms aim to promote overall health and well-being in children.
  • Behavioral Health Screening Form: This form assesses emotional and behavioral health, similar to the Florida Health form's inquiry into social and emotional problems. Both are crucial for identifying any needs that may affect a child's education.
  • School Health Services Consent Form: This document grants permission for school health personnel to provide services. It aligns with the Florida Health form in ensuring that health information can be shared among school staff for a child's benefit.
  • Health History Questionnaire: This form gathers detailed information about a child's medical history, akin to the medical history section of the Florida Health form. Both are designed to inform health care providers about a child's specific health needs.

Dos and Don'ts

When filling out the Florida Health form, there are several important dos and don’ts to keep in mind. Following these guidelines will help ensure that the process goes smoothly and that your child's health information is accurately represented.

  • Do complete all sections of the form clearly and legibly.
  • Do provide accurate and honest answers, especially regarding your child's medical history.
  • Do sign and date the form where indicated to authorize the use of the information provided.
  • Do consult with your healthcare provider about any concerns or questions regarding your child’s health.
  • Don't leave any questions unanswered; if something does not apply, indicate that clearly.
  • Don't provide vague explanations for "Yes" answers; be specific about any health issues.
  • Don't forget to keep a copy of the completed form for your records.

Misconceptions

Misconceptions about the Florida Health form can lead to confusion for parents and guardians. Here are ten common misunderstandings, along with clarifications:

  1. The form is optional. Many believe the Florida Health form is optional, but it is required by state law for school entry.
  2. Only physical health is assessed. Some think the form only covers physical health. In reality, it also addresses emotional and behavioral health.
  3. Parents do not need to sign it. There is a misconception that a signature is not necessary. However, a parent or guardian must sign to confirm the information provided.
  4. Health exams are not time-sensitive. Some believe the health exam can be done at any time. It must be completed within one year of enrollment.
  5. Local school districts have no additional requirements. Many think the form meets all needs. Local districts may have additional requirements, so checking with the school is wise.
  6. All questions must be answered with "Yes" or "No." Some think they cannot provide explanations. However, parents should elaborate on any "Yes" answers to give more context.
  7. Only doctors can complete the form. There is a belief that only physicians can fill it out. However, licensed health care providers, including nurse practitioners, can complete the evaluation.
  8. The form is only for kindergarten students. Some assume it applies only to kindergarteners, but it is for all students entering school for the first time.
  9. Confidentiality is not maintained. A common misconception is that the information is shared widely. In fact, it is kept confidential and used solely for school health services.
  10. Emergency health conditions do not need to be listed. Some think they can skip this section. It is crucial to specify any health conditions that may require emergency action at school.

Understanding these misconceptions can help parents navigate the process more effectively and ensure their child's health needs are met.

Key takeaways

Filling out the Florida Health form is an important step for your child's school entry. Here are some key takeaways to keep in mind:

  • Complete Part I: As a parent or guardian, you must fill out Part I, which includes your child's medical history.
  • Be Honest: Answer all questions truthfully, especially regarding health concerns, allergies, and medications.
  • Provide Details: If you answer "Yes" to any questions, be prepared to explain those answers in the space provided.
  • Health Provider's Role: A qualified health care provider must complete Part II, which includes a physical exam and medical evaluation.
  • Timeliness: Ensure that the health examination occurs within one year of your child's enrollment in school.
  • Follow Recommendations: The form suggests obtaining additional health services, such as vision and dental exams, even though they are not mandatory.
  • Emergency Information: Clearly specify any health conditions that may require emergency action at school, such as allergies or seizures.
  • Confidentiality: The information provided on this form will be kept confidential and used solely for your child's health and educational needs.