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Ensuring the health and wellness of students is a cornerstone of their success in the classroom, a principle that the Georgia Department of Public Health upholds with its comprehensive Form 3300. This Certificate of Vision, Hearing, Dental, and Nutrition Screening plays a pivotal role for any child entering the Georgia public school system for the first time. Mandating thorough assessments in four crucial areas of health, the form ensures early detection of potential problems, thereby facilitating timely intervention and support. The screenings, encompassing vision, hearing, dental, and nutrition, require completion and reporting by a qualified screener before a child’s enrollment. Intriguingly, the provision for conducting these screenings is not limited to physicians alone; local health departments, along with specialized professionals such as licensed optometrists, speech-language pathologists, audiologists, dentists, dental hygienists, registered dieticians, and even school registered nurses, are authorized. The form not only serves as a critical health check but also emphasizes the importance of early detection in managing health issues which can significantly affect a child's learning capabilities. Furthermore, understanding indicators like BMI (Body Mass Index) and its percentile offers insights into a child's nutritional status, guiding further evaluation if necessary. If any section of the form signals a need for further assessment, it prompts parents to seek more comprehensive evaluations from healthcare professionals. Additionally, the continuity of this screening documentation is assured even if a student transfers schools, eliminating redundancy while ensuring the child's health records are up to date. This introduction to Form 3300 highlights its role not only in safeguarding the health of Georgia’s young learners but also in supporting their educational journey from the outset.

Preview - Ga 3300 Form

Georgia Department of Public Health

Form 3300

Certiicate of Vision, Hearing, Dental, and Nutrition Screening

PLEASE SEE THE INSTRUCTIONS

ON THE BACK OF THIS FORM

FILE THIS FORM WITH THE SCHOOL WHEN YOUR CHILD IS FIRST ENROLLED IN A GEORGIA PUBLIC SCHOOL

SCREENER CONTACT INFORMATION IS REQUIRED

Parent/ Guardian Name:_______________________________________

irst

middle

last

Parent/ Guardian Contact Information:

 

 

Daytime phone number:_____________________________________________________________

Evening phone number:_____________________________________________________________

Cell phone number:_________________________________________________________________

Child’s Name:__________________________________________________

irst

middle

last

Date of Birth: _____/_____/_____

Gender: Male Female

Child’s Home Address:

____________________________________________________________________________________

street

city

state

zip code

county

VISION

Unable to screen (explain why below)

Uses corrective lenses

Worn for testing

Passed (20/30 in each eye for age 6 and above, 20/40 in each eye for below age 6)

Needs further evaluation

Under professional care (explain below)

Screening completed by:

Physician

Local Health Department

Optometrist

“Prevent Blindness Georgia” employee

School Registered Nurse

___________________________________

Screener’s Signature Date

I certify that this child has received the above screening.

Contact Information:

HEARING

Unable to screen (explain why below)

Uses hearing aid / assistive device

Passed at 500, 1000, 2000, and 4000 Hz with audiometer at 20 or 25 dB

Needs further evaluation

Under professional care (explain below)

Screening completed by:

Physician

Local Health Department

Audiologist

Speech-Language Pathologist

School Registered Nurse

___________________________________

Screener’s Signature Date

I certify that this child has received the above screening.

Contact Information:

DENTAL

Unable to screen (explain why below)

Normal appearance

Needs further evaluation

Emergency problem observed

Under professional care (explain below)

Screening completed by:

Physician

Dentist

Local Health Department Registered Nurse

Registered Dental Hygienist

School Registered Nurse

___________________________________

Screener’s Signature Date

I certify that this child has received the above screening.

Contact Information:

NUTRITION

Unable to screen (explain why below)

Height: ___________

Weight: ___________

BMI: _____________

BMI%: ___________

5th to 84th percentile - Appropriate for age

< 5th percentile - Needs further evaluation

≥ 85th percentile - Needs further evaluation

Under professional care (explain below)

Screening completed by:

Physician

Local Health Department

Registered Dietician

School Registered Nurse

___________________________________

Screener’s Signature Date

I certify that this child has received the above screening.

Contact Information:

FOR SCHOOL SYSTEM ONLY

Follow up for further evaluation

 

1st attempt

 

2nd attempt

Actions reported (if any)

Vision

 

 

 

 

 

 

 

 

 

Hearing

 

 

 

 

 

 

 

 

 

Dental

 

 

 

 

 

 

 

 

 

Nutrition

 

 

 

 

 

 

 

 

 

Student support services initiated on:

Screeners’ Comments:

DPH FORM 3300 REV. 2013

Georgia Department of Public Health Form 3300

Certificate of Vision, Hearing, Dental, and Nutrition Screening

Who is required to file this Form 3300? The parent or guardian of a child who is being admitted for the first time to a public school in Georgia must file a completed Form 3300 with the school when the child is enrolled.

What is the purpose of Form 3300? Form 3300 is intended to make sure that every child in Georgia is screened for possible problems with their vision, hearing, teeth and nutrition. The earlier these problems are detected, the earlier parents can seek professional help for the child.

What screenings are required? Four different screenings are required: vision, hearing, dental, and nutrition. All four screenings must be conducted and reported on the form before it can be filed with the school.

Who can conduct the screenings? Your child’s doctor is authorized to conduct all four screenings, as is your local health department. In addition, the vision screening can be conducted by a Georgia licensed optometrist, an employee of Prevent Blindness Georgia trained to conduct vision screening, or a school registered nurse; the hearing screening can be conducted by a Georgia licensed speech-language pathologist or audiologist, or a school registered nurse; the dental screening can be conducted by a Georgia licensed dentist, dental hygienist, or a school registered nurse; and the nutrition screening can be conducted by a Georgia licensed dietician or a school registered nurse. It is not necessary that the same person conduct all four screenings.

What does “BMI” and “BMI%” mean? “BMI” means “body mass index.” BMI is a way to describe how

much a child weighs in relation to height. “BMI percentile” is a way to compare the child’s body mass index to the body mass index of a healthy child. If the child’s BMI is less than 5% or more than 84% of what is appropriate for his or her age

and height, then the child should be taken to a doctor or dietician for a more detailed evaluation. For more information, visit

the Centers for Disease Control and Prevention website on child and teen BMI at: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

What should a parent do if the “needs further evaluation” box is checked? “Needs further evaluation”

means that the child may have a problem. If the “needs further evaluation” box is checked, then the parent should

take the child to a professional for a more detailed evaluation. Your doctor or local health department may be able to help, or recommend someone who can help.

What if a Form 3300 was previously filed for the child at another school? It is only necessary to file the Form 3300 once. If the Form 3300 is filed at the child’s first school, and the child later transfers to another school, then the original school is

required to forward the Form 3300 to the new school.

Form Data

Fact Detail
Filing Requirement The parent or guardian must file Form 3300 for a child first enrolling in a Georgia public school.
Purpose of Form 3300 To ensure every child in Georgia is screened for vision, hearing, dental, and nutrition issues.
Screenings Required Form 3300 mandates four screenings: vision, hearing, dental, and nutrition.
Authorized Screeners Doctors, local health department professionals, and other specifically licensed or registered individuals are authorized to conduct screenings.
Understanding BMI "BMI" stands for body mass index, a measure of weight in relation to height. "BMI%" compares the child's BMI to that of a healthy child of the same age and height.
Action for Further Evaluation If marked "needs further evaluation," the child should see a professional for a detailed assessment.
Form 3300 Transferability Once filed, Form 3300 does not need to be resubmitted if the child transfers to another Georgia public school.

Instructions on Utilizing Ga 3300

Filling out the Georgia Department of Public Health Form 3300 is a significant step in ensuring the wellness of children enrolling in Georgia public schools for the first time. This form requires documentation of vision, hearing, dental, and nutrition screenings to identify and address potential health issues early. These screenings can be done by a variety of professionals, and understanding the steps to properly complete this form is crucial for a smooth submission process. The following instructions will guide parents and guardians through each section to ensure no detail is overlooked.

  1. Start by filling out the parent/guardian's name in the designated field, ensuring to include first, middle, and last names.
  2. Enter the parent/guardian's contact information, including daytime, evening, and cell phone numbers.
  3. Provide the child's name (first, middle, and last) in the specified section.
  4. Fill in the child's date of birth and mark the correct gender option.
  5. Complete the section with the child's home address, including street, city, state, zip code, and county.
  6. In the vision section, check the appropriate boxes based on the child's screening results. Specify if the child was unable to be screened, uses corrective lenses, has passed the screening, needs further evaluation, or is under professional care.
  7. Document the screener’s information for the vision test, including their role (physician, optometrist, etc.) and contact information. Sign and date this section.
  8. Repeat steps 6 and 7 for the hearing, dental, and nutrition sections, providing specific results and screener information for each.
  9. For the nutrition screening, you also need to include height, weight, BMI, and BMI percentile.
  10. If any section requires further evaluation, make sure to consult a professional as advised in the instructions and provide any additional comments or explanations in the spaces given.

After all sections are completed, review the form for accuracy and completeness. This form must then be submitted to the child's school upon enrollment. Remember, it's only required to file the Form 3300 once per child for their entire duration in the Georgia public school system. If your child transfers to another school, the original document should be transferred by the initial school to the new one. Accurate and thorough completion of this form plays a crucial role in early detection and management of health matters, providing a solid foundation for your child's educational journey.

Obtain Answers on Ga 3300

  1. Who is required to file the Georgia Department of Public Health Form 3300?

    The parent or guardian of a child being admitted for the first time to a public school in Georgia must file a completed Form 3300 with the school upon the child's enrollment.

  2. What is the purpose of Form 3300?

    The main aim of Form 3300 is to ensure that every child in Georgia undergoes screenings for potential issues concerning their vision, hearing, dental health, and nutrition. Identifying these issues early allows parents to seek the necessary professional assistance sooner.

  3. What screenings are required for Form 3300?

    The form requires four distinct screenings: vision, hearing, dental, and nutrition. All four must be completed and documented on the form before it can be officially filed with the school.

  4. Who is authorized to conduct these screenings?

    Screenings can be performed by your child's doctor or your local health department. Specifically, vision screenings may also be conducted by a Georgia licensed optometrist, a Prevent Blindness Georgia employee, or a school registered nurse. Hearing screenings can be done by a Georgia licensed speech-language pathologist, an audiologist, or a school registered nurse. Dental screenings may be carried out by a Georgia licensed dentist or dental hygienist, and nutrition screenings by a Georgia licensed dietician, both or either of which can alternatively be conducted by a school registered nurse.

  5. What do "BMI" and "BMI%" mean on the form?

    "BMI" stands for body mass index, a measure expressing the ratio of a child's weight to their height. "BMI percentile" compares the child's BMI with what is considered healthy for other children of the same age and height. If a child's BMI falls below the 5th percentile or above the 85th percentile for their age and height, this indicates a need for further evaluation by a doctor or dietician.

  6. What should a parent do if a "needs further evaluation" box is checked?

    If any of the screening sections on Form 3300 are marked as "needs further evaluation," it suggests the child may have a health concern that requires more detailed examination. Parents should then take their child to a healthcare professional for a comprehensive evaluation. Advice and recommendations on where to seek such evaluations can often be provided by your doctor or local health department.

  7. Is it necessary to file Form 3300 more than once if a child changes schools?

    Form 3300 needs to be filed just once. If a child who has already had a Form 3300 filed at one school transfers to another school, the responsibility falls on the original school to forward the form to the new school. There is no need for the parent or guardian to submit another form.

Common mistakes

Completing the Georgia Department of Public Health Form 3300 is vital for your child's admission into a Georgia public school, as it ensures they have undergone essential health screenings. However, people often make mistakes when filling out this form. Understanding and avoiding these common errors can help streamline the process.

  1. Failing to complete all sections: Each section of the form – Vision, Hearing, Dental, and Nutrition Screening – must be filled out. Skipping sections or leaving parts incomplete can delay your child's enrollment.
  2. Not using a licensed professional for screenings: The form requires screenings to be conducted by qualified professionals, such as physicians, optometrists, dentists, or registered nurses. Using non-qualified individuals to conduct screenings is not acceptable.
  3. Incorrectly reporting BMI and BMI%: These are critical for assessing your child's nutrition status. Misinterpreting or inaccurately calculating BMI and BMI% can result in incorrect assessments.
  4. Overlooking the “Needs further evaluation” boxes: If any of these boxes are checked, it indicates that your child may have a health issue that requires professional attention. Ignoring these can have implications for your child’s health.
  5. Omitting contact information for screeners: The form requires contact information for the individuals who conducted the screenings. Leaving this information out can cause delays if clarification or additional information is needed.
  6. Forgetting to sign and date the form: An unsigned or undated form is incomplete. This oversight can invalidate the form, necessitating you to fill it out again.
  7. Misunderstanding screener qualifications: Each screening must be conducted by specific professionals. Assuming that any health professional can perform all screenings is incorrect and can lead to the need for re-screening.
  8. Using outdated forms: Ensure you are using the most current version of Form 3300, as requirements and contact information may change.
  9. Providing incomplete screener contact details: Simply including a name without a phone number or address can prevent school officials from verifying screening results if necessary.
  10. Not following up on recommended evaluations: If the form indicates that further evaluation is needed, failing to act on these recommendations can affect your child’s health and school enrollment.

By being aware of these common mistakes and taking steps to avoid them, parents can ensure that the health screening process is both smooth and efficient, safeguarding their child's health and educational journey.

Documents used along the form

The Georgia Department of Public Health Form 3300 is essential for ensuring that children entering the public school system in Georgia have had their vision, hearing, dental, and nutritional health screened. This form is part of a larger suite of forms and documents that might be needed throughout a child's academic journey. Understanding these additional forms can help parents and guardians ensure that their child's health and educational needs are fully met.

  • Immunization Record Form: A document that records all vaccinations received by the child, required for school enrollment to ensure public health safety.
  • Emergency Medical Authorization Form: This form allows school officials to take necessary action in the event of a medical emergency when parents or guardians cannot be reached.
  • Student Enrollment Form: A comprehensive form required for enrolling a child in school, covering demographic information, emergency contacts, and educational history.
  • Special Education Evaluation Form: If a child may require special education services, this form initiates the evaluation process to determine eligibility and needs.
  • Free and Reduced Price School Meals Application: For families that may need assistance, this form helps determine eligibility for free or reduced-price school meals.
  • Student Transportation Form: This document is used to arrange transportation services for students, such as bus services to and from school.
  • Parental Consent for Field Trip Participation: A form that must be signed by a parent or guardian granting permission for a child to participate in school field trips.
  • Technology Use Agreement Form: As schools increasingly integrate technology into learning, this form outlines acceptable use policies for students using school technology resources.
  • Annual Health Update Form: A form that is typically updated each school year to inform the school of any changes in a child’s health status or medical care plan.

In addition to the Georgia Department of Public Health Form 3300, these documents play a crucial role in supporting a child's educational journey, health, and well-being while complying with school policies and state regulations. By staying informed and proactive in managing these forms, parents and guardians can help ensure that their children have a successful and healthy school experience.

Similar forms

  • The Universal Child Health Record shares a similarity with the Georgia Department of Public Health Form 3300 in its function for comprehensive health checks. Much like the Form 3300, it covers various health aspects but is utilized more broadly across some states for school-aged children. Both documents aim to ensure children meet specific health criteria before entering the public school system. The core components, including checks on vision and hearing, underline a parallel intent to intercept and address health issues early in a child's academic journey.

  • The Immunization Record Form is another document with similarities to Form 3300, focusing specifically on a child's vaccination history. While the Form 3300 encompasses a broader spectrum of health screenings, the Immunization Record zeroes in on vaccination against communicable diseases. Both forms serve a preventive health purpose, aiming to safeguard not only the individual child's well-being but also public health within the school environment.

  • A Dental Examination Form used across various states for school admissions has a dedicated purpose similar to one of the components of the Form 3300. It requires a professional dental assessment to ensure a child's oral health is adequate before starting school. The overlap in intent with Form 3300's dental screening section shows a mutual recognition of dental health as a crucial part of overall well-being in educational readiness.

  • Nutrition Assessment Forms employed in some school districts for evaluating students' nutritional status share commonalities with the nutrition screening part of the Form 3300. Both kinds of documents are tools in identifying potential nutritional problems that could affect a child's health and academic performance. These assessments aim to promote early intervention strategies, whether through medical care or educational programs on healthy eating.

  • Finally, the Sports Physical Examination Form, often a prerequisite for participation in school sports, parallels Form 3300's comprehensive approach by assessing a child's physical fitness for specific activities. Though focusing on fitness for sports rather than general health, these examinations similarly underscore the importance of ensuring a child's physical aptitude and safety within the school setting, addressing concerns like cardiovascular health, which is integral to both forms' underlying objectives.

Dos and Don'ts

Completing the Georgia Department of Public Health Form 3300 is a critical step when enrolling a child for the first time in a Georgia public school. Here are five things you should do and five things you shouldn't do to ensure the process is smooth and effective.

Do:

  1. Ensure that all screenings (vision, hearing, dental, and nutrition) are conducted by a qualified professional as specified on the form. This can be your child's doctor, your local health department, or other specialists listed in the instructions.
  2. Complete all sections accurately, including full names, contact information, and screening results, to avoid any delay in your child's school enrollment.
  3. Check the appropriate boxes for each screening result based on the professional's findings and recommendations.
  4. Remember to get the screening professional to sign and date the form to certify that the screenings have taken place.
  5. File the completed form with the school at the time of enrollment. Keep a copy for your records in case the school needs additional information or loses the original form.

Don't:

  • Attempt to fill out or guess the screening results yourself. All screenings must be conducted by authorized professionals.
  • Leave any sections incomplete. If a section does not apply, make sure to mark it as N/A (Not Applicable) instead of leaving it blank.
  • Forget to check if your child wears corrective lenses or uses a hearing aid, as these details are critical for accurate screening assessments.
  • Overlook any comments or follow-up actions recommended by the screener. If "needs further evaluation" is indicated, make sure to arrange for your child to see a specialist.
  • Wait until the last minute to have these screenings done. Some screenings might require appointments well in advance, and you'll need time to address any issues that might be identified.

Misconceptions

Many people have misconceptions about the Georgia Department of Public Health Form 3300, which is crucial for ensuring children's health as they enroll in public school. Understanding the facts can help parents and guardians navigate the process more effectively.

  • Only doctors can perform the screenings: Contrary to this belief, a variety of professionals can conduct these screenings, including local health department staff, licensed optometrists, speech-language pathologists, audiologists, dentists, dental hygienists, registered dieticians, and school registered nurses. It’s not limited to doctors.

  • Screenings are optional: This is a misunderstanding. The screenings for vision, hearing, dental, and nutrition are mandatory for any child being admitted to a public school in Georgia for the first time.

  • Form 3300 is for school use only: While it is true that the form must be submitted to the school, it primarily serves as a screening tool to identify children who may need professional evaluation or care for vision, hearing, dental, or nutritional issues. Thus, its purpose extends beyond school administrative use.

  • All screenings must be done at the same time: While it’s convenient to have all screenings conducted simultaneously, it's not a requirement. Different professionals authorized to perform these screenings can do so at separate times.

  • If one screening fails, the child cannot be enrolled: This is incorrect. The aim of the screenings is early detection of health issues. A child who may need further evaluation can still be enrolled in school. The appropriate follow-up should, however, be pursued according to the screening results.

  • Form 3300 only addresses physical health: While the form focuses on vision, hearing, dental, and nutrition, recognizing these aspects of a child's health can have a broad impact on their overall physical and academic well-being.

  • BMI information is not crucial: This is a misconception. BMI and BMI% provide essential information about a child’s nutrition and general health. It needs to be accurately reported for early detection of potential health issues.

  • Every child needs to file Form 3300 annually: Only children enrolling in a Georgia public school for the first time need to submit this form. If a child changes schools, the original school should forward the Form 3300 to the new school.

  • Parents cannot access screening services through local health departments: On the contrary, local health departments are fully equipped and authorized to conduct all required screenings. They are an excellent resource for parents seeking assistance with Form 3300.

  • No follow-up is required if a child passes all screenings: Even if a child passes, parents should remain proactive about their health. Regular check-ups are crucial for ongoing wellness beyond these initial screenings.

Understanding these key points ensures that parents and guardians are well informed about the Form 3300 process, contributing to the overall health and well-being of their children as they enter the Georgia public school system.

Key takeaways

Filling out and submitting the Georgia Department of Public Health Form 3300 is an essential step for the parents or guardians of children enrolling in a Georgia public school for the first time. Here are seven key takeaways to help ensure the process goes smoothly:

  • Four Critical Screenings: Form 3300 requires documentation of four distinct screenings: vision, hearing, dental, and nutrition. Each of these screenings plays a vital role in identifying potential health issues that could impact a child's learning and development.
  • Who Can Conduct Screenings: A variety of professionals are authorized to perform these screenings, including physicians, Georgia licensed dentists, optometrists, audiologists, speech-language pathologists, registered dieticians, and even school registered nurses. Parents have flexibility in choosing who conducts their child's screenings based on availability and preference.
  • Understanding BMI and BMI%: Nutrition screening includes calculating the Body Mass Index (BMI) and comparing it to percentile ranges to assess if a child's weight is appropriate for their age and height. A child's placement outside the 5th to 84th percentile indicates a need for further evaluation by a healthcare professional.
  • Action Required if "Needs Further Evaluation" is Checked: Should any screening indicate that further evaluation is necessary, it is crucial for parents to follow up promptly with a suitable healthcare provider. This step ensures that any potential issues are addressed early on to support the child's health and educational experience.
  • Only One Form Needed: Once Form 3300 is filed for a child at their first Georgia public school, it's not required to be filed again, even if the child transfers to another school. The initial school is responsible for forwarding the form to any new school the child attends.
  • Screenings Cover Broad Health Aspects: The required screenings cover a comprehensive range of health aspects—from vision and hearing, which can directly affect learning, to dental health and nutrition, which play crucial roles in overall physical well-being and development.
  • Coordination with Healthcare Providers: Given that various professionals can conduct the screenings, it's an excellent opportunity for parents to coordinate with their child's healthcare providers. This coordination ensures that all aspects of the child's health are monitored and managed comprehensively.

Approaching Form 3300 with these key points in mind will help ensure that this important part of school enrollment goes as smoothly as possible, supporting both the child's health and their capacity to succeed in the educational environment.

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