The Health For Florida form, specifically the DH 3040, is an essential document designed to streamline the process of entering the educational system in Florida for students from Pre-Kindergarten to grade 12. As mandated by Florida statutes, this form facilitates a smooth transition into the school environment by ensuring that all health-related requirements are satisfactorily met before enrollment. It outlines a comprehensive health screening protocol that not only covers general health checks but also includes vision and hearing screenings, thereby addressing key aspects of a child's wellness that could impact their educational journey. A unique aspect of this form is the inclusivity it extends towards homeless children by providing a temporary exemption, demonstrating an understanding of diverse student situations. Additionally, it respects parents' rights to opt-out based on religious beliefs, ensuring that diverse backgrounds are considered in its application. The form requires detailed information from healthcare providers who are licensed within Florida or the state where the exam is performed, ensuring credibility and reliability in the examination results. The DH 3040 is designed with a dual-purpose approach; not only does it serve health and screening functions, but it also acts as a critical document for information sharing between parents, healthcare providers, and educational institutions, thus portraying an integrated approach to student health and well-being as they step into a new academic environment.
| Question | Answer |
|---|---|
| Form Name | Health Form For Florida |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | school physical form florida pdf, texas dads form 3040, fkorida school health form 3040, florida health form dh 3040 |
Guide for Completing the School Entry Health Exam (DH 3040 Form)
DH 3040, 6/02, Stock Number:
General Information
Purpose: The School Entry Health Exam has been designed to meet the requirements for the school entry health examination, as mandated by s.1003.22, F.S. (formerly s. 232.0315, F.S.) for student entry into Florida public and private schools, grades
Health Care Provider: A health professional who is licensed in Florida or in the state where the student resided at the time of the health examination, and who is authorized to perform a general health examination under such licensure shall certify that the health examination has been completed.
Time Limits: The child’s health examination must be completed within one year prior to enrollment in school. A homeless child shall be given a temporary exemption for 30 school days.
Exemptions: A child shall be exempt from this requirement upon written request from parent or guardian on religious grounds.
Copies: A copy of the front and back of the completed form may be retained in the child’s medical file kept by the health care provider. The original completed DH 3040 Form should be given to the parent to take to the school to provide information and to document that this requirement is met.
Directions for completing the School Entry Health Exam Form
Page 1: The health history is to be filled in by the parent or interviewer in the provider’s office. If the parent seeks the exams recommended by the Partnership for School Readiness, the appropriate provider will fill in the information regarding the exam results.
1.Child Identifying Information: Fill in all of the information requested, including child’s middle name and parent’s complete names. This information is critical for distinguishing between children with the same or similar name.
2.PART
3.Partnership for School Readiness Recommendations for
Page 2: This page is to be completed by the health care provider only.
1.Fill in the complete name and birth date of the child, as it appears on page 1.
2.PART
3.Screening Results: Perform the indicated screenings and fill in the results of each of the indicated screenings, including vision and hearing information.
4.Exam Components: Indicate whether the results of the exam are normal or abnormal and any actions taken by the provider.
5.TB Risk Assessment: See guidelines on the bottom of the page for TB risk assessment. The screening and results should not be recorded on the school health form. If a test is given, arrangements should be made with the parent/guardian for follow up.
6.If the child has any physical or behavioral problem that may adversely affect the educational experience, check the appropriate box and explain the impairment or restrictions. Because the record will not be subject to the strict protection of medical records, providers are asked to refrain from including information of a confidential nature such as child abuse and HIV/AIDS.
7.Participation in Activities: Indicate whether the child has health or physical conditions that would prevent participation in normal school activities such as physical activities in recess, physical education or other physical activities during the school day.
8.Provider information: Fill out or stamp the form to provide information that identifies the provider and their address.
Revised 7/02