Article Structure
For parents navigating the process of enrolling their child in a Georgia public school, the Form 3300 plays a crucial role in ensuring the well-being of students. This certificate addresses various health screenings, including vision, hearing, dental, and nutrition assessments, all of which are necessary for first-time school enrollment. The form must be completed and submitted by the child's parent or guardian, establishing a comprehensive health baseline as the child embarks on their educational journey. With designated sections for each screening, the form allows healthcare professionals—from physicians to school nurses—to document results and certifications of the child's health status. By checking the appropriate boxes, they indicate whether the child passed the screenings, needs further evaluation, or is under professional care. This proactive approach not only aids in the early detection of possible health issues but also helps parents understand how to seek necessary follow-ups if concerns arise. Understanding the importance of this form fosters a collaborative effort between parents and schools to support children’s health, thus setting the stage for a successful school experience.
Ga 3300 Example
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
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
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 Characteristics
| Fact Name | Description |
|---|---|
| Purpose of Form 3300 | Form 3300 ensures screening for vision, hearing, dental, and nutrition issues for children in Georgia public schools. |
| Who Must File | The parent or guardian must file Form 3300 when a child is first enrolled in a Georgia public school. |
| Required Screenings | Four screenings are required: vision, hearing, dental, and nutrition. |
| Who Can Conduct Screenings | Screenings can be conducted by physicians, local health departments, registered nurses, and specific licensed professionals. |
| BMI Definition | BMI stands for body mass index and measures weight in relation to height. |
| BMI Percentiles | BMI percentile compares a child’s BMI to that of healthy peers to identify potential issues. |
| Further Evaluation Indicator | If a check box for “needs further evaluation” is marked, a professional assessment is recommended. |
| Filing for Transferred Students | Form 3300 need only be filed once; the original school forwards it if the student transfers. |
| Date of Revision | The current version of Form 3300 was revised in 2013. |
| Contact Information | Contact information for parents/guardians is mandatory on the form for follow-ups. |
Guidelines on Utilizing Ga 3300
Completing the Georgia Form 3300 is essential for ensuring your child's health screenings are documented when enrolling in a public school. This form requires important information about vision, hearing, dental, and nutrition screenings. Here’s how to fill it out step by step.
- Begin by entering your child's name. Fill in the first, middle, and last name in the designated space.
- Next, provide your child's date of birth using the format MM/DD/YYYY.
- Indicate your child's gender by checking the appropriate box: Male or Female.
- Fill in your child's home address. Include the street, city, state, ZIP code, and county.
- Complete the vision screening section. Check the appropriate box according to the results and provide any additional explanations if required.
- On the same form, complete the hearing screening section. Again, check the box that applies and add any necessary explanations.
- Proceed to the dental screening section. Mark the suitable option and add explanations if needed.
- Fill out the nutrition screening area. Enter your child's height, weight, BMI, and BMI percentile. Check the appropriate box based on the results.
- Make sure that the screening information is completed by a qualified professional and their signature is included.
- Finally, ensure you have your contact information listed clearly for both daytime and evening phone numbers.
Once you have filled out the form, review it for any mistakes or missing information. It’s important to turn this in to the school promptly to avoid any delays in your child's enrollment process.
What You Should Know About This Form
Who is required to file this Form 3300?
The parent or guardian of a child must file a completed Form 3300 with the school when the child is enrolled for the first time in a public school in Georgia. It is essential to ensure that the necessary screenings are documented at enrollment.
What is the purpose of Form 3300?
Form 3300 is designed to ensure that every child in Georgia receives screenings for vision, hearing, dental health, and nutrition. Early detection of any issues allows parents to seek help promptly, promoting the child's overall well-being.
What screenings are required?
Four screenings are required: vision, hearing, dental, and nutrition. Each screening must be performed and reported on the form before submission to the school. All screenings are necessary for a comprehensive health record.
Who can conduct the screenings?
Authorized individuals for conducting these screenings include physicians, local health department officials, and school registered nurses. Additional options exist for each category: a licensed optometrist for vision, a licensed audiologist or speech-language pathologist for hearing, and a licensed dentist or dental hygienist for dental screening. The nutrition screening can be completed by a registered dietician. It is not required for one individual to perform all screenings.
What does “BMI” and “BMI%” mean?
BMI stands for body mass index, which measures weight relative to height. The BMI percentile compares a child's BMI to that of healthy children of the same age and height. If a child’s BMI is under the 5th percentile or over the 84th percentile, a detailed evaluation from a doctor or dietician is recommended.
What should a parent do if the “needs further evaluation” box is checked?
If the box indicating "needs further evaluation" is checked, it signifies a potential issue. Parents should take the child to a healthcare professional for a thorough assessment. Local health departments or the child's doctor can provide assistance or recommendations.
What if a Form 3300 was previously filed for the child at another school?
A Form 3300 only needs to be filed once. If it has already been submitted at the child's first school, that school must forward the form to any new school the child transfers to. This helps maintain an accurate health record as the child moves through the educational system.
Common mistakes
Filling out the GA 3300 form requires attention to detail, and mistakes can lead to delays in your child’s enrollment in a public school. One common error is leaving sections incomplete. This may include not providing necessary contact information for the parent or guardian. Each blank space can lead to misunderstandings or miscommunications that could slow down the enrollment process.
Another significant mistake is selecting incorrect options for screenings. Parents may inadvertently check the wrong boxes, indicating whether their child has passed vision, hearing, dental, or nutrition screenings. It is crucial to ensure that the information accurately reflects the child's status, as inaccurate reporting may necessitate additional evaluations.
Additionally, failing to provide the screener's signature is a frequent oversight. Each screening section requires the screener to sign off on the results. Without this signature, the form is incomplete and may be rejected by the school, causing further delays in processing.
Many parents also forget to include the date of the screenings. This information is essential for the school to validate that the screenings were performed within the appropriate timeframe. Missing a date could lead to unnecessary questions from school officials and complicate your child's admission.
Moreover, confusion around the BMI and BMI% sections can lead to inaccuracies. Some may not understand how to calculate these values or may neglect to measure and record their child's height and weight accurately. This section is critical for assessing nutritional health, and errors here can result in a need for further evaluation.
Lastly, not understanding the “needs further evaluation” options can create complications. Parents should be aware that if this box is checked, it indicates potential problems that should be addressed by a healthcare professional. Ignoring this suggestion could lead to an oversight in your child's health needs, impacting their educational experience.
Documents used along the form
The GA 3300 form is essential for enrolling a child in a public school in Georgia, ensuring that they have received required health screenings. Several other documents work alongside it to facilitate a smooth enrollment process. Below are five commonly used forms that are often submitted with the GA 3300.
- GA 3200 Form: This form is the "Certificate of Immunization". It certifies that a child has received the required vaccinations before entering school. Schools need this form to comply with state health regulations.
- GA 4420 Form: Known as the "Enrollment Form," this document collects essential information about the child and their family for school records. It includes details like the child's name, address, and emergency contacts.
- Proof of Residency: This document verifies that the family resides within the school district. It may include utility bills, lease agreements, or similar paperwork to confirm residence.
- Gifted Eligibility Evaluation Form: If applicable, this form assesses whether a child qualifies for gifted education programs. It gathers relevant data such as academic performance and teacher recommendations.
- Special Education Records: For children requiring special education services, these documents provide information about the child’s specific needs and any existing Individualized Education Plans (IEP).
Gathering and submitting these documents can help ensure that your child is well-prepared and meets all enrollment requirements. It's crucial to check with the specific school for any additional forms that may be needed. This way, the enrollment process will be efficient and straightforward.
Similar forms
- Form 3141 - Georgia Immunization Record: This form also serves as a health record required for school enrollment. It documents immunizations given to a child, similar to how Form 3300 records health screenings.
- Form 3300 - Certificate of Vision, Hearing, Dental, and Nutrition Screening: Related to the GA 3300, this document focuses specifically on the screenings required before school entry, as well as ensuring ongoing health checks.
- Form 2600 - Health Assessment Form: This form gathers additional health information about the child. Like the GA 3300, it seeks to assess overall health and readiness for school participation.
- Form 3200 - Student Health History: It requires parents to provide detailed health histories, similar to the comprehensive health information collected by the GA 3300.
- Form 126 - Vision and Hearing Screening Report: This document focuses purely on vision and hearing evaluations, paralleling the screening sections of the GA 3300 form.
- Emergency Care Plans: These documents outline specific medical needs and responses required in emergencies, akin to how the GA 3300 addresses health screening needs.
- Form 122 - BMI Screening Form: This form records a child’s body mass index, closely related to the nutrition screening portion of the GA 3300.
- Form 770 - Public Health Screening Referral: This document serves as a referral for further health evaluations, similar to recommendations made in the GA 3300 form when additional evaluation is necessary.
Dos and Don'ts
When filling out the GA 3300 form, there are important guidelines to keep in mind. Here’s a list of do’s and don’ts to ensure the process goes smoothly.
- Do fill out the form accurately and completely, providing all necessary information.
- Do have all required screenings completed before submitting the form.
- Do ensure that the screenings are conducted by authorized professionals.
- Do keep a copy of the completed form for your records.
- Do file the form with the school as soon as your child is enrolled.
- Don’t leave any sections blank; all relevant information must be filled out.
- Don’t forget to include contact information for the screener.
- Don’t check the “needs further evaluation” box without consulting a professional.
- Don’t alter or change any pre-printed information on the form.
- Don’t submit the form without confirming all screenings have been completed.
Misconceptions
Understanding the Georgia Department of Public Health Form 3300 can be challenging. It’s essential to clear up some common misconceptions to ensure that parents and guardians are well-informed about the requirements and procedures. Here are seven misconceptions about this important form:
- Only vision screening is required. In reality, all four screenings—vision, hearing, dental, and nutrition—must be completed and reported on the form.
- Any healthcare provider can conduct the screenings. Only specific professionals, like a licensed physician or dentist, can perform the required screenings. Some screenings can also be done by school nurses, but not all screenings are permissible by any practitioner.
- The form needs to be resubmitted if the child changes schools. This is incorrect. Once the Form 3300 is filed for a child at their first school, it does not need to be submitted again if the child transfers. The original school is responsible for forwarding it to the new school.
- Parents can ignore the 'needs further evaluation' check. This is a serious misconception. If this box is checked, it indicates a potential problem. Parents must seek a professional evaluation for their child’s health and well-being.
- Filing the form is optional. This is false. It’s mandatory for parents or guardians of children entering public school in Georgia for the first time to submit the completed Form 3300.
- BMI calculations are unnecessary for school entry. This is not true. The nutrition screening includes BMI assessments as part of ensuring that children are within healthy height and weight ranges.
- The screenings can be conducted at any time. Timeliness is crucial. The screenings must be performed before the child starts at a Georgia public school, so parents should not delay.
It's pivotal to be well-informed and proactive. Understanding the details about the Form 3300 can help ensure a smooth transition into school for the child and can foster a focus on their health and development.
Key takeaways
Filling out the GA 3300 form is an essential step for parents and guardians enrolling their children in Georgia public schools. Here are key takeaways to understand its significance and usage:
- Mandatory Submission: Parents or guardians must file the completed GA 3300 form when their child is first enrolled in a public school in Georgia.
- Four Required Screenings: The form documents the results of four essential screenings: vision, hearing, dental, and nutrition, ensuring comprehensive health evaluation.
- Qualified Conductors: Various qualified professionals, including physicians, registered nurses, and optometrists, can perform the necessary screenings. It's not required for the same individual to conduct all screenings.
- Screening Importance: Early detection of potential health issues through these screenings can lead to timely intervention and management, benefiting the child's overall well-being.
- BMI Measurements: The form includes BMI (Body Mass Index) and its percentile, which helps assess a child's weight in relation to their height. Values below 5% or above 84% may indicate the need for further evaluation.
- Next Steps for Evaluation: If any screening indicates "needs further evaluation," it is crucial for parents to seek professional assessments to address potential health issues.
- Form Transferability: If the GA 3300 form has been filed at a previous school, the original form will be forwarded to the new school by the former institution, eliminating the need for resubmission.
Browse Other Templates
Is Property Tax Based on Purchase Price - The form can affect future property taxes if successful in its claims.
Does Dish Have Contracts - Use this form as a tool for navigating landlord communications about satellite services.