MCH213G PDF Details

The parent or guardian completes Part I. The Medical Provider completes Part II and Part III.

Before school entry: this form must be completed no earlier than one year before your child's entry into school.

Part III: a qualified licensed physician, nurse practitioner, or physician assistant must complete Part III.

Part III exam: the exam must be done no longer than one year before entry into kindergarten or elementary school.

Part II signature: the form must be signed and dated by the Medical Provider or Health Department Official in the appropriate box.

Tuberculosis screening: CXR required if positive test for TB infection or TB symptoms.

QuestionAnswer
Form NameMCH213G
Form Length4 pages
Fillable?Yes
Fillable fields427
Avg. time to fill out60+ min
Edition10/2020
Who signsParent or Legal Guardian; Medical Provider or Health Department Official
Matches the agency's fileYes, checked October 2, 2026
Other namesMCH213G, MCH 213G, MCH-213-G, MCH 213 G, Virginia school health form, VA school entrance health form, Commonwealth of Virginia School Entrance Health Form
Official sourceMCH213G (Rev 10/2020),

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  • CRE-1

    The Code of Virginia allows a child an exemption from receiving immunizations required for school attendance if the student or the student's parent/guardian submits an affidavit to the school's admitting official stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. Any student entering school must submit this affidavit on a CERTIFICATE OF RELIGIOUS EXEMPTION (Form CRE-1), which may be obtained at any local health department, school division superintendent's office or local department of social services.