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The Health For Florida form, specifically known as the School Entry Health Exam (DH 3040), plays a crucial role in ensuring that children are prepared for their educational journey in Florida's public and private schools, from Pre-Kindergarten through 12th grade. This form is designed to fulfill state requirements set forth in Florida Statute 1003.22, which mandates a health examination prior to school entry. It gathers essential health and screening information that aids school personnel in addressing the health needs of each child. A licensed health care provider must complete the examination, certifying its completion and ensuring that it occurs within one year before the child's enrollment. Special provisions exist for homeless children, allowing for a temporary exemption, while parents can request exemptions on religious grounds. The form includes sections for the child's medical history, screening results, and a medical evaluation, all of which must be accurately filled out to provide a comprehensive view of the child's health. Parents are encouraged to seek additional health screenings, such as vision and dental exams, to further support their child's readiness for school. Understanding how to properly complete this form is essential for parents and guardians, as it not only documents compliance with state regulations but also promotes the overall well-being of the child as they embark on their educational experience.

Documents used along the form

When completing the Health For Florida form, several other documents and forms may be necessary to ensure compliance with health regulations for school entry. Each of these documents serves a specific purpose and helps facilitate the health and well-being of students as they enter the educational system.

  • DH 680 Form: This form is a Florida Certificate of Immunization. It documents a child's immunization history, ensuring that they have received the necessary vaccinations before entering school.
  • DH 3040 Form: Also known as the School Entry Health Exam form, this document provides essential health information and screening results required for school enrollment.
  • Health History Form: This form collects detailed information about a child's medical history, allergies, and any chronic conditions that may affect their school experience.
  • Emergency Contact Form: This document lists individuals who can be contacted in case of an emergency, ensuring that the school can reach someone promptly if a child needs assistance.
  • Medication Authorization Form: If a child requires medication during school hours, this form must be completed by a parent or guardian, detailing the medication and dosage to be administered.
  • Vision and Hearing Screening Results: Schools may request results from specific vision and hearing screenings, which help identify any issues that could impact a child's learning.
  • Physical Examination Form: This document records the findings of a comprehensive physical exam conducted by a healthcare provider, which may be required for certain sports or activities.
  • Special Needs Assessment Form: If a child has special needs, this form outlines the specific accommodations or services required to support their educational experience.
  • Student Health Insurance Information: This document provides details about a child's health insurance coverage, which can be important for accessing healthcare services while at school.
  • Consent for Treatment Form: Parents or guardians may need to sign this form to give consent for school personnel to provide medical treatment in case of injury or illness.

These forms work together to create a comprehensive health profile for each student, ensuring that schools can meet their health and educational needs effectively. Proper documentation is crucial for the safety and well-being of children as they embark on their academic journeys.

Similar forms

The Health For Florida form, also known as the School Entry Health Exam (DH 3040), shares similarities with the Immunization Record form. Both documents are essential for school enrollment, ensuring that children meet health standards before attending school. The Immunization Record provides a detailed account of the vaccinations a child has received, which is crucial for preventing the spread of infectious diseases. Just like the DH 3040, the Immunization Record must be completed by a licensed health care provider and submitted to the school, confirming that the child is protected against various preventable illnesses.

Another document akin to the Health For Florida form is the Florida Certificate of Health Examination (DH 680). This certificate serves as proof that a child has undergone a comprehensive health examination, similar to the requirements outlined in the DH 3040. The DH 680 includes information about the child's immunization status and health history, which schools need to ensure a safe environment for all students. Like the DH 3040, the DH 680 must be filled out by a licensed health care provider and submitted to the school upon enrollment.

The Child Health Assessment form is another relevant document. This form provides a broader evaluation of a child's overall health, including physical, mental, and developmental assessments. While the Health For Florida form focuses on specific health screenings required for school entry, the Child Health Assessment offers a more comprehensive view of a child's health status. Both forms aim to ensure that children are fit for school and can participate in educational activities without health-related barriers.

Additionally, the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) form is similar in purpose. EPSDT is a Medicaid program that ensures children receive regular health check-ups and necessary treatments. Like the Health For Florida form, it emphasizes preventive care and early detection of health issues. Both documents require information from a health care provider and serve as a means to safeguard children's health as they enter the school system.

The Physical Examination form is another document that parallels the Health For Florida form. This form is often used in various contexts, including sports participation and school enrollment, to document a child's physical health status. While the DH 3040 specifically addresses school entry requirements, the Physical Examination form can be utilized in multiple settings to ensure that children are physically fit for various activities. Both documents necessitate a licensed health care provider's signature, confirming that the examination has been completed.

In addition, the School Health Record is a document that shares similarities with the Health For Florida form. This record is maintained by the school and includes information about a student's health history, immunizations, and any medical conditions that may affect their schooling. Like the DH 3040, the School Health Record aims to provide a comprehensive overview of a child's health, ensuring that schools can adequately support students' health needs throughout their educational journey.

The Health History form, often required by schools, is another comparable document. This form collects detailed information about a child's medical history, including allergies, chronic conditions, and past surgeries. While the Health For Florida form focuses on the health examination specifically required for school entry, the Health History form provides a broader context for understanding a child's health needs. Both documents serve to inform school health personnel and ensure that appropriate measures are taken to support the child's well-being.

Finally, the Consent for Treatment form is similar in that it involves parental involvement in a child's health care. This form grants permission for health care providers to administer treatment or conduct examinations. While the Health For Florida form documents the results of a health examination, the Consent for Treatment form ensures that parents are informed and involved in their child's health decisions. Both forms emphasize the importance of collaboration between parents and health care providers in promoting children's health as they enter the school environment.

Obtain Answers on Health For Florida

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

    The Health For Florida form, specifically the School Entry Health Exam (DH 3040 Form), is designed to fulfill the requirement for health examinations mandated by Florida law for students entering public and private schools from Pre-Kindergarten to 12th grade. This form collects essential health and screening information to assist school health personnel in addressing the needs of each child.

  2. Who can complete the School Entry Health Exam?

    A licensed health care provider in Florida or in the state where the student resided during the health examination can complete the form. This provider must be authorized to perform general health examinations under their licensure. It is crucial that the examination is conducted by a qualified professional to ensure accuracy and compliance with state regulations.

  3. What are the time limits for completing the health examination?

    The health examination must be completed within one year prior to the child's enrollment in school. However, homeless children are granted a temporary exemption, allowing them 30 school days to complete the examination after enrollment.

  4. Are there any exemptions to the health examination requirement?

    Yes, a child may be exempt from the health examination requirement if a parent or guardian submits a written request citing religious grounds. This exemption must be documented to ensure compliance with school policies.

  5. What should be done with the completed DH 3040 Form?

    The original completed DH 3040 Form should be provided to the parent, who will then take it to the school. It is also recommended that a copy of the front and back of the form be retained in the child’s medical file by the health care provider for record-keeping purposes.

  6. What information is required on the School Entry Health Exam Form?

    The form requires various details, including the child's identifying information, medical history, and results from screenings such as vision and hearing tests. The health care provider will also document any physical or behavioral issues that could impact the child's educational experience. It is essential to ensure that all information is accurate and complete for proper assessment and support.

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Guide for Completing the School Entry Health Exam (DH 3040 Form)

DH 3040, 6/02, Stock Number: 5744-000-3040-2

General Information

Purpose: The School Entry Health Exam has been designed to meet the requirements for the school entry health examination, as mandated by s.1003.22, F.S. (formerly s. 232.0315, F.S.) for student entry into Florida public and private schools, grades Pre-Kindergarten to 12. It provides basic health and screening information that will assist the school and school health personnel in meeting the needs of the child.

Health Care Provider: A health professional who is licensed in Florida or in the state where the student resided at the time of the health examination, and who is authorized to perform a general health examination under such licensure shall certify that the health examination has been completed.

Time Limits: The child’s health examination must be completed within one year prior to enrollment in school. A homeless child shall be given a temporary exemption for 30 school days.

Exemptions: A child shall be exempt from this requirement upon written request from parent or guardian on religious grounds.

Copies: A copy of the front and back of the completed form may be retained in the child’s medical file kept by the health care provider. The original completed DH 3040 Form should be given to the parent to take to the school to provide information and to document that this requirement is met.

Directions for completing the School Entry Health Exam Form

Page 1: The health history is to be filled in by the parent or interviewer in the provider’s office. If the parent seeks the exams recommended by the Partnership for School Readiness, the appropriate provider will fill in the information regarding the exam results.

1.Child Identifying Information: Fill in all of the information requested, including child’s middle name and parent’s complete names. This information is critical for distinguishing between children with the same or similar name.

2.PART I—CHILD’S MEDICAL HISTORY: The parent or interviewer in the provider’s office should answer these questions before the exam. All questions answered “yes” should be explained in the space provided below.

3.Partnership for School Readiness Recommendations for Pre-kindergarten and Kindergarten: After the school entry health exam form has been completed, parents should be encouraged to seek the recommended vision examination from an optometrist or ophthalmologist and the dental examination from a dentist. The practitioner providing the school entry health exam may provide the hearing screening.

Page 2: This page is to be completed by the health care provider only.

1.Fill in the complete name and birth date of the child, as it appears on page 1.

2.PART II—MEDICAL EVALUATION: Provide the month, day and year of the entry exam.

3.Screening Results: Perform the indicated screenings and fill in the results of each of the indicated screenings, including vision and hearing information.

4.Exam Components: Indicate whether the results of the exam are normal or abnormal and any actions taken by the provider.

5.TB Risk Assessment: See guidelines on the bottom of the page for TB risk assessment. The screening and results should not be recorded on the school health form. If a test is given, arrangements should be made with the parent/guardian for follow up.

6.If the child has any physical or behavioral problem that may adversely affect the educational experience, check the appropriate box and explain the impairment or restrictions. Because the record will not be subject to the strict protection of medical records, providers are asked to refrain from including information of a confidential nature such as child abuse and HIV/AIDS.

7.Participation in Activities: Indicate whether the child has health or physical conditions that would prevent participation in normal school activities such as physical activities in recess, physical education or other physical activities during the school day.

8.Provider information: Fill out or stamp the form to provide information that identifies the provider and their address.

Revised 7/02

Dos and Don'ts

When completing the Health For Florida form, there are important dos and don'ts to keep in mind. Following these guidelines can help ensure that the process goes smoothly and that all necessary information is provided.

  • Do fill in all requested child identifying information, including the child's middle name and both parents' complete names.
  • Do answer all medical history questions honestly, providing explanations for any "yes" answers in the designated space.
  • Do ensure that the health examination is completed within one year prior to the child's enrollment in school.
  • Do encourage parents to seek additional recommended examinations, such as vision and dental checks, after completing the form.
  • Do provide accurate and complete information regarding any health conditions that may affect the child's educational experience.
  • Don't leave any sections of the form blank, as incomplete information can lead to delays in processing.
  • Don't include confidential information, such as details about child abuse or HIV/AIDS, as this record is not protected like medical records.
  • Don't forget to have the health care provider fill out their information, including their name and address, on the form.
  • Don't submit the form without ensuring that all screenings have been performed and results recorded accurately.
  • Don't overlook the importance of checking for any health conditions that might restrict participation in school activities.