Report of Health Examination For School Entry

pm171a.xml

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                    <title xml:lang="en">Report of Health Examination For School Entry</title>
                    <description xml:lang="en">To protect the health of children, California law requires a health examination on school entry. Please have this report filled out by a health examiner and return it to the school. </description>
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                            <text>&lt;div&gt;&lt;strong style="line-height: 1.5em;"&gt;NOTE&lt;/strong&gt;&lt;span style="line-height: 1.5em;"&gt;: All tests and evaluations except the blood lead test must be done after the child is 4 years and 3 months of age.&lt;/span&gt;&lt;/div&gt;</text>
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                            <label>Physical Examination</label>
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                            <label>Dental examination</label>
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                            <label>Nutritional Assessment</label>
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                            <label>Vision Screening</label>
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                            <label>I give permission for the health examiner to share the additional information about the health check-up with the school as explained in Part III.</label>
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                            <label>Part III - Additional information from health examiner</label>
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                            <label>Part I - To be filled out by parent or guardian</label>
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                            <label>Part II - To be filled out by health examiner</label>
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