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Protocol for Distribution of MCH 213F (School Entrance Health Form)

The Code of Virginia § 22.1-270 requires documentation of a comprehensive physical examination upon entry to public kindergarten or elementary school.  The State Health Commissioner is responsible for defining the content of this comprehensive physical exam, and the Division of Child and Adolescent Health (DCAH), in partnership with the Division of Immunizations and Department of Education (DOE), designs and maintains the form consistent with that definition.

The School Entrance Health Form will be available for use by parents enrolling a child in public schools.  Child care providers, private schools, Head Start programs, day camps, or others who use the form for their convenience will be able to download and print it.

Health care providers should direct parents to obtain the form from the internet or from the public elementary school where the child will be enrolled.

The following constitutes how copies of the form will be made available:

• The form will be sent in quantity to all School Nurse Coordinators, or their designee, for distribution to all elementary schools in their Division.  Shipping will be limited to ONE contact per Division. Register contact information here.
• The amount sent to each School Nurse Coordinator will be based on the Division’s estimated need (past enrollment for pre-K through Kindergarten, plus an additional number to satisfy new elementary school enrollment).  Changes to the amount schools receive can be made here.
• Forms will be shipped to School Nurse Coordinators twice/year – in January and June – with one-half of the total amount for each Division sent in each shipment.
• One month prior to the scheduled shipment, each School Nurse Coordinator will be able to notify DCAH here if they DO NOT need the upcoming shipment.
• There will be no special requests to limit amounts to partial shipments; School Nurse Coordinators will be responsible for assuring that their Division’s elementary schools have an adequate inventory to disperse to parents as requested between shipments; if Coordinators feel they need more or fewer forms on hand, they can request that their regularly scheduled shipments be re-sized.  DCAH will confer with DOE staff about enrollment projections to assure a reasonable volume is sent.
• Each elementary school will have an identified point of contact from which parents may obtain forms.
• School points of contact should not distribute forms to health care providers or organizations in their communities (e.g., child care providers, private schools) or for use by parents enrolling children in such programs.  In these cases, the requester should be directed to download the form from the internet.
• Local health departments may order the form as needed from the Virginia Department of Health Central Services.  Local health departments will be limited to two packets (100 forms) at a time.
• Like schools, Health Department personnel should not distribute forms to providers or organizations in their communities (e.g., child care providers, private schools) or for use by parents enrolling children in such programs.  In these cases, the requester should be directed to download the form from the internet.

 

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