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The Florida Health form is an essential document for parents and guardians as they prepare their children for school entry. This form serves multiple purposes, primarily focusing on the child's medical history and health evaluation. Parents must complete Part I, which includes questions about their child's general health, any allergies, and specific medical conditions. This section helps identify any health concerns that might affect the child’s learning experience. Additionally, the form outlines recommendations for necessary health services, such as vision and dental examinations, to ensure that any potential issues are addressed early on. Part II is reserved for the health care provider, who must conduct a thorough physical examination and document the child's health status, including growth metrics and any medical conditions that may require special attention. The information collected is crucial not only for the school’s records but also for tailoring health services to meet each child's unique needs. By completing this form, parents actively participate in their child's health and educational journey, ensuring a supportive environment for learning.

Documents used along the form

When preparing for your child's school entry, the Florida Health form is just one important document among several others that may be required. Understanding these additional forms can help ensure a smooth transition into the school environment. Below is a list of commonly used documents that often accompany the Florida Health form.

  • Immunization Record: This document provides a detailed history of your child's vaccinations. Schools typically require proof of immunizations to ensure that all students are protected against preventable diseases. It includes dates of vaccinations and the specific vaccines administered.
  • Emergency Contact Form: This form is crucial for keeping your child safe while at school. It lists individuals who can be contacted in case of an emergency. It’s important to keep this information updated to ensure quick communication when necessary.
  • Consent for Medical Treatment: This document grants permission for school personnel to seek medical treatment for your child in case of an emergency. It often includes information about your child's medical history and any allergies, ensuring that first responders have the necessary information to provide care.
  • Special Health Care Needs Form: If your child has specific health conditions that require special accommodations or support at school, this form outlines those needs. It helps school staff understand how to best support your child's health and educational experience.

Being proactive about these forms not only helps with your child's school entry but also fosters a supportive environment for their health and well-being. Make sure to gather all necessary documents and consult with your healthcare provider if you have any questions.

Similar forms

The Florida Health form shares similarities with the Child Health Assessment form, which is often required for school entry. Both documents aim to collect comprehensive health information about a child to ensure they are fit for school. The Child Health Assessment form typically includes sections for medical history, immunization records, and physical examination results, similar to the Florida Health form's emphasis on health concerns, allergies, and any necessary accommodations for learning. Both forms serve the purpose of safeguarding children's health and educational experiences.

Another comparable document is the School Health Record, which is maintained by many school districts. This record tracks a child's health history and any significant health issues that may affect their schooling. Like the Florida Health form, the School Health Record requires input from parents or guardians and health care providers. It often includes details about vision, hearing, and other screenings, ensuring that children receive appropriate support and interventions as needed.

The Individualized Education Program (IEP) is also similar in that it addresses the health and educational needs of children with disabilities. While the IEP is more focused on special education services, it includes health assessments that can mirror those found in the Florida Health form. Both documents require collaboration between parents, educators, and health professionals to create a supportive environment tailored to the child's specific needs.

The Pre-Kindergarten Health Assessment form serves a similar purpose by ensuring that children entering pre-kindergarten are healthy and ready for school. This form often includes medical history, developmental milestones, and health screenings. Like the Florida Health form, it emphasizes the importance of early detection of health issues that could impact a child's ability to learn and socialize effectively in a school setting.

The Sports Physical Examination form is another document that parallels the Florida Health form, especially for children participating in school sports. This form assesses a child's physical readiness for athletic activities, similar to how the Florida Health form evaluates overall health. Both documents require a thorough examination by a health care provider and include recommendations or restrictions based on the child's health status.

The Immunization Record is a critical document that also aligns with the Florida Health form. It tracks a child's vaccination history, which is essential for school entry in Florida. Both forms require accurate and up-to-date information to ensure that children are protected against preventable diseases, thereby contributing to the overall health of the school community.

The Well-Child Visit Report, typically completed by pediatricians, is similar in that it provides a comprehensive overview of a child's health during routine check-ups. This report includes developmental assessments, immunizations, and health screenings, paralleling the components of the Florida Health form. Both documents serve to inform parents and schools about a child's health status and any necessary follow-up actions.

Lastly, the Health History Questionnaire used by many pediatricians is comparable to the Florida Health form. This questionnaire gathers detailed information about a child's medical history, family health background, and any current health concerns. Both documents aim to create a complete picture of a child's health, which is essential for both educational and medical purposes, ensuring that children receive the care and support they need for optimal development.

Obtain Answers on Florida Health

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

    The Florida Health form is designed to ensure that children receive a comprehensive health examination before entering school. This form collects essential information about a child's medical history and current health status, which is necessary for schools to provide appropriate health services and support.

  2. Who needs to fill out the Florida Health form?

    Parents or guardians of children entering school in Florida are required to complete this form. It is important that they provide accurate and thorough information regarding their child's health history, as this information will be used by school staff and health personnel to address the child's health and educational needs.

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

    Part I focuses on the child's medical history. Parents or guardians must answer questions regarding general health, specific illnesses, allergies, medications, vision, hearing, and any significant injuries. If any questions are answered with "Yes," further explanations are required in the provided space.

  4. What should I do if my child has health concerns?

    If your child has health concerns, it is crucial to discuss these with your healthcare provider. The form also recommends obtaining comprehensive vision, dental, and hearing examinations. Addressing any health issues early can help ensure your child is ready to learn and participate fully in school activities.

  5. What is included in Part II of the form?

    Part II is completed by a healthcare provider and includes a thorough medical evaluation of the child. This section requires details such as height, weight, vision, hearing, and any health conditions that may impact the child's educational experience. The healthcare provider will also indicate if the child can participate fully in school activities.

  6. How is this form used by schools?

    The information provided on the Florida Health form is stored in the child's Cumulative Health Folder. School staff and health personnel may access this information to ensure that the child's health needs are met while at school. This can include planning for any necessary accommodations or emergency actions.

  7. Are there any additional requirements for school entry?

    While the Florida Health form is a primary requirement, local school districts may have additional health requirements. It is advisable for parents or guardians to check with their specific school district for any extra documentation or health screenings that may be needed before enrollment.

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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

 

Please describe any corrective action for any problems detected and

 

Date of Exam:

 

 

 

any accommodations required.

 

Results of Exam:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dentist:

 

 

 

 

 

 

 

 

 

 

 

 

3. Hearing Screening

 

 

 

Please describe any corrective action for any problems detected and

 

Date of Exam:

 

 

 

any accommodations required.

 

Results of Exam:

 

 

 

 

 

 

 

 

 

 

 

 

 

Health Care Provider:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DH3040-CHP-07/2013

Name of Child (Last, First, Middle)

School Entry Health Exam Page 2 of 2

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:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vision - Without Glasses

 

Right 20/_____

 

Left 20/_____

Passed

 

Hearing – Right

 

Passed

Failed

 

Referred

 

 

 

 

 

 

 

 

 

 

 

 

Failed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vision - With Glasses

 

Right 20/_____

 

Left 20/_____

 

 

Hearing – Left

 

Passed

Failed

 

Referred

 

 

 

 

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:

 

 

 

 

 

 

 

 

 

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

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.

DH3040-CHP-07/2013

Dos and Don'ts

When filling out the Florida Health form, it is essential to ensure accuracy and completeness. Below is a list of dos and don’ts to guide you through the process.

  • Do print clearly to ensure all information is legible.
  • Do provide accurate details about your child’s medical history, including any concerns.
  • Do check all relevant boxes for questions 1 through 8 regarding your child's health.
  • Do explain any "Yes" answers in the space provided to give context.
  • Do sign and date the form to confirm that you are the parent or guardian.
  • Don’t leave any sections blank; incomplete forms may delay processing.
  • Don’t provide false information, as this can have serious implications for your child's health care.
  • Don’t forget to include your contact information, such as your home telephone number.
  • Don’t skip the recommendations for additional health services, even if they are not mandatory.
  • Don’t ignore the need for a health care provider’s signature in Part II of the form.