Have a licensed medical professional complete part 2-4.
Vision: for children 3-6 years of age, only a (Pass/Fail) will be required; those age 6 years and over will require vision acuity levels.
Lead tests: this section is only for children under age 6 years; every child must have 2 lead tests by age 2.
Lead levels: all lead levels must be reported to DC Childhood Lead Poisoning Prevention; call (202) 481-3837 or fax (202) 535-2607.
TB: positive TB tests should be referred to Primary Care Provider for evaluation.
Treatment: if the child has Rx/treatment, attach a complete Medication/Medical Treatment Plan form.
| Question | Answer |
|---|---|
| Form Name | Universal Health Certificate |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 250 |
| Avg. time to fill out | 42 min |
| Edition | Rev 04/26/2024 |
| Issuing agency | DC Health |
| Matches the agency's file | Yes, checked October 3, 2026 |
| Other names | DC Universal Health Certificate, universal health form, dc health form, DC health certificate |
| Official source | Universal Health Certificate (Rev 04/26/2024), DC Health |
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