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Certificate of Record for Vision Screen and/or Eye Examination and Hearing Screening Child s Name: Date of Birth: Date of Exam: Vision: Right: 20/ Left: 20/ With correction PASS / FAIL Without correction
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How to fill out Allen ISD Certificate of Record for Vision Screen and/or
01
Obtain the Allen ISD Certificate of Record for Vision Screen form from the school's website or administration office.
02
Fill in the student's personal information including name, date of birth, and grade level.
03
Provide the date of the vision screening and the name of the practitioner who performed it.
04
Record the results of the vision screening in the designated area on the form.
05
Sign and date the form, ensuring all information is accurate.
06
Submit the completed form to the appropriate school authority, either in person or via email.
Who needs Allen ISD Certificate of Record for Vision Screen and/or?
01
Students who are undergoing vision screening as part of the health requirements in Allen ISD.
02
Parents or guardians of students who need to document their child's vision screening results.
03
School administrators who require vision screening records for compliance and reporting.
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What is Allen ISD Certificate of Record for Vision Screen and/or?
The Allen ISD Certificate of Record for Vision Screen is a document used to record the results of vision screening conducted on students within the Allen Independent School District.
Who is required to file Allen ISD Certificate of Record for Vision Screen and/or?
The certificate must be filed by designated school personnel who conduct vision screenings as part of the health assessments mandated by the school district.
How to fill out Allen ISD Certificate of Record for Vision Screen and/or?
To fill out the certificate, school personnel must include student identification details, screening results, any referrals for further evaluations, and the date of the screening.
What is the purpose of Allen ISD Certificate of Record for Vision Screen and/or?
The purpose of the certificate is to document the vision health of students, ensuring that those in need of vision care are identified and referred appropriately.
What information must be reported on Allen ISD Certificate of Record for Vision Screen and/or?
The information required includes the student's name, identification number, date of birth, results of the vision screening (pass/fail), and any additional notes or referrals.
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