Homepage Free Ga 3300 Template in PDF
Table of Contents

Embarking on the educational journey in Georgia means crossing paths with the Georgia Department of Public Health Form 3300, a critical piece in ensuring a child's well-being as they step into a public school for the first time. This form is not merely a piece of paper but a comprehensive certificate of vision, hearing, dental, and nutrition screening that places the health of children at the forefront of school readiness. Its requirement underscores a commitment to early detection of potential health issues, thus facilitating timely intervention and care. Whether it’s a question of fitting glasses to correct vision or addressing nutritional needs that align with a child’s growth, the Form 3300 is designed to cover crucial health checkpoints. Authorized professionals, ranging from physicians to school nurses, lend their expertise to conduct these screenings, ensuring a multi-faceted evaluation of the child’s health. The form also introduces parents to terms like BMI and its significance, nudging families towards further exploration of their child’s health needs when necessary. Importantly, it streamlines the process of keeping the child’s health records Updated as they move through the school system, making the Form 3300 a pivotal element in the collaboration between health services and educational institutions to bolster the well-being and academic readiness of Georgia’s children.

Form Sample

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.

File Overview

Fact Description
Form Purpose The Georgia Department of Public Health Form 3300 is designed to ensure children entering Georgia public schools for the first time are screened for vision, hearing, dental, and nutrition issues.
Who Must File Parents or guardians of a child being first enrolled in a Georgia public school must file this completed form with the school.
Required Screenings Form 3300 mandates four screenings: vision, hearing, dental, and nutrition before the child can be enrolled.
Authorized Screeners Screenings can be conducted by, among others, a physician, local health department, licensed optometrist for vision, licensed audiologist or speech-language pathologist for hearing, licensed dentist or dental hygienist for dental, and a registered dietitian for nutrition.
BMI Understanding "BMI" stands for Body Mass Index, a measure of body fat based on height and weight. "BMI%" compares a child's BMI against that of healthy children the same age and height.
Action on "Needs Further Evaluation" If the form indicates a need for further evaluation in any area, parents are advised to seek a more comprehensive assessment from a relevant professional.
Form Reusability Once filed at the child's first Georgia public school, there's no need to file it again if the child transfers to another school within the state—the original school will forward Form 3300 to the new school.
Governing Law This form is governed by the rules and regulations of the Georgia Department of Public Health and the state's education requirements.

Guide to Using Ga 3300

Filling out the Georgia Department of Public Health Form 3300 is a critical step for ensuring your child is ready and eligible to enroll in a Georgia public school. This form is designed to report on four key health screenings: vision, hearing, dental, and nutrition. These screenings are essential for identifying potential health issues early on, allowing for timely intervention and support. To complete this form, you'll need to have each screening performed by an authorized professional. Once completed, the form must be submitted to the school upon your child's enrollment. Here's a step-by-step guide to help you navigate through filling out Form 3300.

  1. Start by entering the Parent/Guardian Name (first, middle, last) and Contact Information, including daytime, evening, and cell phone numbers.
  2. Fill in the Child's Name (first, middle, last), Date of Birth, and check the appropriate box for Gender.
  3. Enter the Child’s Home Address, including street, city, state, zip code, and county.
  4. For the Vision Screening section, check the relevant boxes that apply to your child’s vision status and provide explanations if necessary. Indicate if corrective lenses were used during the test.
  5. In the Hearing Screening section, mark the appropriate outcomes and note if a hearing aid or assistive device is used. Provide details for any further evaluation needed.
  6. The Dental Screening segment requires information on the general appearance of the teeth or any emergency problems observed. Indicate if there is a need for further evaluation or ongoing professional care.
  7. In the Nutrition Screening area, fill in the height, weight, BMI, and BMI%. Check the box that corresponds to your child’s BMI percentile range and note any recommendations for further evaluation or professional care.
  8. Ensure that each screening section is signed and dated by the appropriate screener, along with their contact information. Screeners can include physicians, local health department staff, optometrists, dentists, registered dieticians, or school registered nurses, depending on the screening.
  9. If any of the sections were unable to be screened or if further evaluation is needed, provide clear explanations in the spaces provided.
  10. For school system use only: Schools will detail follow-up for further evaluation attempts, actions reported, and if student support services were initiated.

Once the Georgia Department of Public Health Form 3300 is fully completed, review it to ensure accuracy and completeness. This form plays a crucial role in your child’s school enrollment process, serving as a measure to promote health and early detection of issues. Submit the form to the school as part of your child’s enrollment documentation, and keep a copy for your records. Early preparation and attention to detail will make the submission process smooth and seamless.

Obtain Clarifications on Ga 3300

  1. Who is required to file the Form 3300?

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

  2. What is the purpose of Form 3300?

    Form 3300 is designed to ensure that every child in Georgia undergoes screenings for potential issues with vision, hearing, dental health, and nutrition. Early detection allows parents to seek appropriate professional assistance for their child.

  3. What screenings are required by Form 3300?

    The form mandates four different screenings: vision, hearing, dental, and nutrition. All four screenings must be completed and recorded on the form before it can be submitted to the school.

  4. Who is eligible to conduct these screenings?

    Your child's doctor, as well as your local health department, are authorized to perform all four screenings. Additionally, vision screenings can be done by a Georgia licensed optometrist, an employee of Prevent Blindness Georgia, or a school registered nurse. Hearing screenings may be conducted by a Georgia licensed speech-language pathologist, audiologist, or a school registered nurse. Dental screenings can be performed by a Georgia licensed dentist, dental hygienist, or a school registered nurse. Nutrition screenings can be conducted by a Georgia licensed dietician or a school registered nurse. Different individuals can perform each screening.

  5. What do "BMI" and "BMI%" mean?

    "BMI" stands for Body Mass Index, which is a measure of body fat based on a child's weight in relation to their height. "BMI percentile" compares a child's BMI to that of a healthy child of the same age and height to determine if the child's BMI falls below the 5th percentile or above the 84th percentile, indicating a need for a more detailed evaluation by a doctor or dietician.

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

    If the "needs further evaluation" box is checked for any screening, it suggests that the child may have a health issue that requires more detailed investigation. Parents should follow up with a medical professional, such as a doctor or a relevant specialist recommended by their doctor or local health department, for a comprehensive evaluation.

  7. What if a Form 3300 has already been filed for the child at another school?

    If Form 3300 has already been filed for a child at their first school, and the child later transfers to a different school, it is not necessary to file the form again. The original school is responsible for forwarding Form 3300 to the new school.

  8. Where can more information be found regarding child and teen BMI?

    For additional information on child and teen BMI, including how it is calculated and its significance, parents can visit the Centers for Disease Control and Prevention (CDC) website specifically addressing child and teen BMI at http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html.

Common mistakes

When filling out the Georgia Department of Public Health Form 3300, it's important to provide accurate and comprehensive information. However, there are common mistakes people often make during this process. To ensure your form is correctly completed, be aware of the following pitfalls:

  1. Not checking off the appropriate boxes for each of the required screenings (vision, hearing, dental, and nutrition). Each section must be filled out to reflect the current status of the child’s health.

  2. Forgetting to include the screener’s contact information or leaving sections incomplete. Every screening section requires the name and signature of the screener as well as their contact details.

  3. Omitting the child's details, such as their full name, date of birth, or gender, which are crucial for identifying the health records.

  4. Failing to specify the child's use of corrective lenses or hearing aids if applicable, which is important for understanding the child’s current health needs.

  5. Overlooking the need to explain why a child was unable to be screened, if that's the case. This information is critical for determining next steps.

  6. Misinterpreting the BMI and BMI% sections, leading to incorrect reporting of nutritional health. Understanding these metrics is essential for accurate documentation.

  7. Submitting the form without ensuring that all "needs further evaluation" boxes that are checked are followed up with detailed comments or action plans for addressing any identified issues.

Avoiding these mistakes not only facilitates a smoother enrollment process for your child but also ensures that any potential health issues are addressed promptly. Remember, the purpose of Form 3300 is to safeguard the health and well-being of every child in Georgia schools through early detection and care.

Documents used along the form

The Georgia Department of Public Health Form 3300 is a crucial document ensuring every child entering a Georgia public school for the first time goes through necessary health screenings. This proactive approach helps in the early detection and treatment of issues related to vision, hearing, dental health, and nutrition, setting a foundation for a healthy academic journey. To complement the Form 3300, several other forms and documents are often utilized to provide a comprehensive view of a child's health and educational readiness. Here's a closer look at some of these essential documents.

  1. Immunization Record (Form 3231): This document certifies that a child has received all required vaccinations according to the Georgia Department of Public Health's schedule, ensuring the child's and the school community's health and safety.
  2. Emergency Contact and Medical Information Form: Schools use this form to collect contact information of parents or guardians and important health details, ensuring quick action in case of emergencies.
  3. Birth Certificate: A certified copy of the child's birth certificate is usually required for enrollment to verify the child's age and guardianship.
  4. Social Security Card: A copy may be requested for identification purposes and to ensure accurate records for services the child may receive.
  5. Proof of Residency: Documents like utility bills or rental agreements verify the child's residence in the school's catchment area.
  6. Academic Records: Previous report cards and test scores help the new school understand the child's academic history and needs.
  7. Special Education Records (IEP or 504 Plan): If the child receives special education services, these documents ensure that those services continue seamlessly in the new environment.
  8. Custody Agreement: For children whose parents are separated or divorced, a custody agreement may be necessary to clarify guardianship and contact rights.

Together, these documents provide a holistic view of the child's needs, achievements, and legal standing, complementing the health screenings of Form 3300. They enable schools to create a supportive learning environment tailored to the child's unique requirements, promoting not only academic success but also well-being. This comprehensive approach underscores the importance of collaboration between parents, health professionals, and educators in fostering the development and health of Georgia's children.

Similar forms

  • The Form DS-3053: Statement of Consent for Issuing a Passport to a Child shares similarities with the Georgia Form 3300, as both require parental or guardian consent for services relating to minors. While the DS-3053 pertains to passport issuance, the Form 3300 is for health screening, yet both involve parental responsibility and acknowledgment.

  • Immunization Records Forms, used across various states, resemble the Georgia Department of Public Health Form 3300 in their purpose of ensuring child health and safety through preventive measures. Both forms are essential for school enrollment, focusing on the well-being of the child — the former on vaccination history and the latter on screening for health issues.

  • Emergency Contact and Medical Information Forms provided by schools share the essence of ensuring child safety, similar to Form 3300. These forms collect crucial health data and emergency contact details, allowing appropriate action if health concerns arise, underscoring the priority of child health and safety.

  • Pre-Participation Physical Evaluation forms, commonly required for student-athletes before engaging in sports, echo the proactive health screening approach of Form 3300. Both identify health concerns early, aiming to address potential barriers to participation, whether in sports or in a standard school setting.

  • The Individualized Education Program (IEP) documents, though focused on educational goals and accommodations for students with disabilities, parallel the structured assessment and tailored intervention spirit of Form 3300. Each plays a crucial role in ensuring that children receive the support they need, either for their health or educational success.

  • Child Health and Developmental History Forms, often used by pediatricians or early intervention programs, are akin to Form 3300 as they both collect comprehensive health information to monitor and support a child's development, highlighting the importance of early detection and intervention.

  • Dental Examination Forms for school-aged children, mandatory in some states for school enrollment, are directly comparable to the dental section of Form 3300. Both forms aim to identify and address dental issues early, preventing future health complications and promoting overall health.

  • Nutritional Assessment Forms used by registered dietitians or in school health programs share objectives with the nutrition screening component of Form 3300. Each assesses dietary habits and nutritional status to recommend interventions, emphasizing the role of nutrition in child health and development.

  • Vision Examination Forms, similar to the vision section of Form 3300, are employed to assess and correct vision problems in children to support their academic and social growth, demonstrating the critical nature of early vision screening and intervention.

  • Hearing Screening Forms used in newborns and school-aged children's health evaluations mirror the hearing screening aspect of Form 3300. Both identify hearing issues that could impact communication and learning, advocating for early detection and management.

Dos and Don'ts

When filling out the Georgia Department of Public Health Form 3300, a Certificate of Vision, Hearing, Dental, and Nutrition Screening, it is crucial to adequately prepare and complete the form to ensure the health and educational success of the child being enrolled in a Georgia public school for the first time. Here are seven important do's and don'ts to consider:

  • Do read through the entire form and instructions carefully before beginning to fill it out to ensure you understand every requirement.
  • Do ensure that all screenings (vision, hearing, dental, and nutrition) are completed by authorized professionals as specified on the form, such as your child’s doctor, a local health department professional, or other listed qualified individuals.
  • Do fill out each section completely, providing thorough and accurate information about the child’s screenings to ensure that the school can provide the necessary support.
  • Do provide clear contact information for both the parent/guardian and the screener(s), ensuring that the school can reach out if additional information or follow-up is necessary.
  • Do consult a professional for a detailed evaluation if any of the screenings indicate that the child “needs further evaluation,” and maintain records of these consultations.
  • Don’t rush through the form or leave sections incomplete; missing information can delay the enrollment process and the provision of necessary support services for the child.
  • Don’t hesitate to seek clarification or assistance from the child’s healthcare provider or the school if you are unsure about how to complete any part of the form or if you have questions about the screening results.

By following these guidelines, parents and guardians can ensure that all required health screenings are properly reported, facilitating a smoother enrollment process and helping to secure the well-being and educational needs of the child.

Misconceptions

Many individuals have misconceptions about the Georgia Department of Public Health Form 3300, which is vital for the enrollment of children in Georgia public schools. Understanding these misconceptions can help ensure compliance with state requirements and support children's well-being.

  • Misconception 1: Form 3300 is only a requirement for students with known issues.

    Reality: All children enrolling in a Georgia public school for the first time must have this form completed, regardless of their health status.

  • Misconception 2: Any healthcare provider can complete the form.

    Reality: Only authorized professionals, including physicians, optometrists, dentists, audiologists, and specific registered nurses, are approved to conduct and sign off on the required screenings.

  • Misconception 3: Screenings must be done by the same professional.

    Reality: Different qualified professionals can perform the vision, hearing, dental, and nutrition screenings; they do not have to be conducted by the same person.

  • Misconception 4: If a child passes one part, they don't need to complete the others.

    Reality: The form requires all four screenings to be completed and reported. All sections are mandatory for filing with the school.

  • Misconception 5: The form is optional for private school students.

    Reality: While the form is specifically designed for public school enrollees, understanding the importance of these screenings is beneficial for all children, including those attending private schools.

  • Misconception 6: BMI and BMI% are not significant measures.

    Reality: These measurements are crucial indicators of a child's nutritional status, comparing their body mass index to what is healthy for their age and height.

  • Misconception 7: Parents need to seek further evaluation only if there's an emergency problem observed.

    Reality: Parents should seek a detailed evaluation from a professional if the "needs further evaluation" box is checked for any reason, indicating a potential issue.

  • Misconception 8: A new Form 3300 must be filed if a child transfers to another school.

    Reality: Only one Form 3300 is necessary. If a child moves to another Georgia public school, the initial school is responsible for forwarding the completed Form 3300 to the new school.

  • Misconception 9: Digital submissions of the form are acceptable.

    Reality: Currently, the completed form must be filed with the school in hard copy. Always check with the specific school for their requirements, as processes may update over time.

Understanding these details about Form 3300 ensures compliance with Georgia's public health requirements and supports early detection and management of potential health issues in children.

Key takeaways

The Georgia Department of Public Health Form 3300 is an integral part of ensuring the health and well-being of children enrolled in the state's public schools. This document serves as a certificate of vision, hearing, dental, and nutrition screening, critical in identifying early signs of potential health issues. Here are key takeaways about filling out and utilizing the GA 3300 form effectively.

  • The primary purpose of Form 3300 is to screen Georgia's school-aged children for vision, hearing, dental, and nutritional health problems that could impair their ability to learn and develop effectively.
  • It is mandatory for a parent or guardian to file a completed Form 3300 with the school when a child is first enrolled in a Georgia public school.
  • The form requires the documentation of screenings in four areas: vision, hearing, dental, and nutrition. Each of these screenings plays a vital role in identifying health issues that might affect a child's academic performance and overall well-being.
  • Authorized professionals such as physicians, licensed optometrists, dentists, dieticians, audiologists, speech-language pathologists, and registered nurses can conduct the required screenings, ensuring that the evaluations are performed by experts in each area.
  • If a child wears corrective lenses or uses a hearing aid, this information must be indicated on the form to provide a complete health profile to school health officials and educators.
  • The form includes a section where screeners must indicate whether a child has passed the screenings or needs further evaluation in any of the four areas, guiding parents on whether additional professional consultation is necessary.
  • Body Mass Index (BMI) and BMI percentile are used in the nutrition screening to assess a child's weight relative to height, screening for potential malnutrition or obesity, which can significantly impact a child's health.
  • For children who transfer to another Georgia public school, the Form 3300 follows them; it is the responsibility of the original school to forward the completed form to the new school, eliminating the need for re-screening.
  • The form asks for screener contact information and a signature, providing a means for schools or parents to follow up if there are questions or concerns about the screening results.
  • Parents are urged to take action if the "needs further evaluation" box is checked for any screenings, as this is an indication that the child may have a health issue that requires professional attention.
  • Checking the form and website of the Centers for Disease Control and Prevention for more information on children's BMI and healthy weight assessments can provide valuable insights and resources for parents.

In conclusion, Georgia's Form 3300 is a crucial step in preparing children for a successful educational experience by addressing potential health barriers early on. Understanding and promptly completing this form can significantly contribute to a child's academic success and overall well-being.

Please rate Free Ga 3300 Template in PDF Form
4.81
Exemplary
21 Votes