Free Ga 3300 Form in PDF

Free Ga 3300 Form in PDF

The Georgia Department of Public Health Form 3300 is essential for the enrollment of a child in a Georgia public school for the first time, requiring certificates of vision, hearing, dental, and nutrition screening. This form must be completed and filed with the child's school, showcasing that the child has been screened for potential issues in these critical areas of health. To ensure your child is ready for school and any health concerns are addressed early, click the button below to fill out the Form 3300.

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The Georgia Department of Public Health Form 3300 is a crucial document for any parent or guardian who is enrolling their child in a Georgia public school for the first time. This form serves as a certificate of vision, hearing, dental, and nutrition screening, which are all essential areas of health that can significantly impact a child's ability to learn and thrive in a school environment. These screenings are designed to identify any potential problems early on, allowing parents to seek out the necessary professional assistance as soon as possible. A range of qualified professionals, including doctors, nurses, and specialists within each screening area, are authorized to conduct these screenings. Moreover, the form includes sections for each type of screening and requires detailed information about the screening results, including whether further evaluation is recommended. The importance of this form goes beyond mere formalities; it underscores a commitment to the well-being and academic success of Georgia's children by ensuring they are physically prepared to face the challenges of schooling. Understanding and completing the Form 3300 is a significant step towards this goal, highlighting the broader efforts to support children's health statewide.

Preview - Ga 3300 Form

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

Speech-Language Pathologist

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 speech-language pathologist or audiologist, or a school registered nurse; the dental screening can be conducted by a Georgia licensed dentist, dental hygienist, or a school registered nurse; and the nutrition screening can be conducted by a Georgia licensed dietician or a school registered nurse. It is not necessary that the same person conduct all four screenings.

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.

Document Specs

Fact Number Fact About GA Form 3300
1 The GA Form 3300 is mandated for children first enrolling in a Georgia public school.
2 This form ensures children are screened for potential issues in vision, hearing, dental health, and nutrition.
3 Screenings can be performed by various professionals including physicians, optometrists, dentists, and registered nurses.
4 Vision screenings require passing a 20/30 vision test for children aged 6 and above, and 20/40 for those below age 6.
5 Hearing screenings involve tests at specific frequencies and decibels to ensure normal hearing capacity.
6 Dental screenings assess the general health of teeth, identifying any emergency issues or need for further evaluation.
7 Nutrition screenings include measurements of height, weight, and Body Mass Index (BMI) against age-related percentiles.
8 "Needs further evaluation" status prompts parents to seek professional evaluation for any detected concerns.
9 Once completed, the original school is responsible for transferring Form 3300 if the child moves to another school.
10 Governing Law: This form is mandated under Georgia's health regulations to ensure child wellness in public schools.

Instructions on Writing Ga 3300

Filling out the Georgia Department of Public Health Form 3300 is a critical step when enrolling your child for the first time in a Georgia public school. This form is essential for ensuring your child has been screened for vision, hearing, dental, and nutrition issues, highlighting the importance of early detection and intervention. The process involves a few straightforward steps that allow healthcare professionals to certify your child's health status in these key areas.

  1. Begin by filling out the Parent/Guardian Name and Contact Information, including daytime, evening, and cell phone numbers to ensure you can be reached if needed.
  2. Enter your Child's Name, including first, middle, last names, alongside their Date of Birth and Gender.
  3. Provide your Child's Home Address, detailing the street, city, state, zip code, and county.
  4. In the Vision section, indicate the relevant status—whether your child passed, needs further evaluation, uses corrective lenses, or was unable to be screened, and include a brief explanation if needed. Remember to mark who completed the screening.
  5. Repeat a similar process for the Hearing section, including the outcome of the screening and who conducted it.
  6. For the Dental section, indicate the look of your child’s teeth—normal, needs further evaluation, an emergency problem observed, or if they were unable to be screened. Also, denote who performed the screening.
  7. In the Nutrition section, include measurements for height, weight, BMI (Body Mass Index), and BMI%. Based on these figures, indicate the appropriate status and the professional who conducted the screening.
  8. Each section requires the screener’s signature and the date, attesting to the accuracy of the information provided.

After completing this form with accurate details, it must be submitted to your child's school to comply with Georgia’s public health requirements. This ensures your child receives the necessary support and interventions early, contributing to their overall well-being and academic success. Remember, this form is a critical part of initial school enrollment in Georgia, facilitating prompt follow-ups for any concerns identified during the screening process.

Understanding Ga 3300

Who is required to file the Form 3300?

Parents or guardians of children who are being admitted for the first time into a public school in Georgia must submit a fully completed Form 3300 at the time of enrollment.

What is the purpose of Form 3300?

The primary purpose of Form 3300 is to ensure that every child in Georgia undergoes screenings for potential problems in their vision, hearing, teeth, and nutrition. Identifying issues early increases the likelihood that intervention can begin promptly.

What screenings are required on Form 3300?

Form 3300 requires four different screenings: vision, hearing, dental, and nutrition. Each of these areas must be screened and the results reported on the form before it can be officially filed with the school.

Who can conduct the screenings required for Form 3300?

The screenings can be conducted by a range of professionals. A child's doctor or the local health department are authorized to perform all four screenings. Additionally, specific screenings may be done by licensed professionals or trained personnel in relevant fields, such as a Georgia licensed optometrist for vision screening, a speech-language pathologist or audiologist for hearing screening, a dentist or dental hygienist for dental screening, and a dietician for nutrition screening. School registered nurses are also able to conduct any of the four screenings.

What do "BMI" and "BMI%" mean on the Form 3300?

"BMI" stands for Body Mass Index, a measurement that calculates a child's weight in relation to their height. The "BMI percentile" compares a child’s BMI to what is typical for other children of the same age and height. If a child's BMI is below the 5th percentile or above the 85th percentile, it suggests that the child should see a doctor or dietician for a more in-depth evaluation.

What should a parent do if the "needs further evaluation" box is checked?

If any section of the form indicates that further evaluation is needed, it means there may be a concern that requires professional attention. Parents should arrange for their child to see a healthcare professional who can provide a detailed assessment. The child’s regular doctor, the local health department, or specialists recommended by these providers are good starting points for obtaining this additional evaluation.

Common mistakes

When filling out the Georgia Department of Public Health Form 3300, a common mistake people make is not completing all required sections. This form consists of vision, hearing, dental, and nutrition screenings. Each section requires specific information about the child's health and screening results. Leaving sections incomplete can delay the enrollment process because the form must be entirely filled out before a child can be admitted to a Georgia public school for the first time.

Another mistake often made is misunderstanding what "BMI" and "BMI%" stand for, which leads to incorrect or incomplete entries in the nutrition section. "BMI" means Body Mass Index, a measurement that compares weight to height. "BMI%" refers to the percentile ranking based on the child's BMI, comparing it to others of the same age and gender. Misinterpreting these terms can result in inaccuracies that may overlook a child's need for further nutrition evaluation. Proper understanding and accurate reporting in these fields are crucial.

Often, parents and guardians overlook the importance of screener contact information. Each screening section requires the contact details of the individual or organization that performed the screening. This mistake can cause significant issues if the school needs to follow up on the screening results. Ensuring the screener's contact information is accurate and complete enables efficient communication between the school and the screener if further clarification or action is needed regarding a child's health screening results.

Lastly, a frequent oversight is not paying attention to the instruction that screenings can be conducted by different qualified professionals. Some believe that only a child’s primary healthcare provider can complete this form. However, vision screenings can be done by optometrists, employees of Prevent Blindness Georgia, or school registered nurses, among others. Similarly, audiologists, speech-language pathologists, dentists, dental hygienists, registered dieticians, and school registered nurses are among the professionals authorized to conduct the respective screenings. This misunderstanding can lead to delays in completing the form due to scheduling difficulties or other obstacles. Knowing who is qualified to perform each screening can streamline the process significantly.

Documents used along the form

When filing the Georgia Department of Public Health Form 3300 for a child's enrollment in a Georgia public school, it's essential to understand that this document does not stand alone. To ensure a comprehensive approach to a child's healthcare and readiness for school, several other forms and documents frequently complement the Form 3300. Knowing these associated documents can help streamline the enrollment process and ensure all health-related requirements are met.

  • Immunization Record (Form 3231): This document is crucial for verifying that a child has received all required vaccinations according to state law before enrolling in a Georgia public school. It provides a detailed record of each vaccine received, ensuring the child meets the state's immunization requirements for school attendance.
  • Emergency Medical Information Form: Schools often require this form to have a quick reference for a child's emergency contacts and crucial health information, such as allergies, chronic conditions, and the child's primary healthcare provider. This information is vital for ensuring the safety and well-being of the child in emergency situations.
  • Authorization for Medication Administration Form: If a child needs to take medication during school hours, this form allows school personnel to administer prescribed medication. It details the medication's name, dosage, and times it's to be administered, along with the physician's and parent's or guardian's signatures.
  • Individualized Education Program (IEP): For children with identified disabilities, an IEP outlines the specific educational and health-related accommodations or services required for the child to succeed in the school environment. While not mandated for every child, it is essential for those it pertains to and works alongside Form 3300 to ensure comprehensive support.

By thoroughly preparing and submitting these documents in conjunction with Form 3300, parents and guardians can aid in providing a full picture of the child’s health and educational needs. This holistic approach ensures that all children have the necessary support and accommodations to thrive in their educational journey. Understanding and organizing these forms as part of the enrollment process emphasizes the importance of a child's health and well-being in their academic success.

Similar forms

The Form 3300 from the Georgia Department of Public Health is analogous to several other health-related screening and documentation forms used across the United States, each tailored to monitor and ensure the well-being of individuals, especially children, within various public and private institutions. One such document is the Universal Child Health Record, often used in states like New Jersey. This form, similar to Form 3300, is required for children entering public schools for the first time and covers a range of health checks including immunizations, medical history, and physical assessments, aimed at identifying any potential health issues that could affect a child’s educational experience.

Another akin document is the School Entry Health Exam Certificate, prevalent in states like Florida, which mandates a comprehensive health examination covering vision, hearing, growth measurements, and a general physical appraisal. This form, akin to the Form 3300, ensures that health barriers to learning are identified and addressed early on, facilitating a better educational experience for entering students.

The California School Immunization Record is a document focused more narrowly than the Form 3300 but shares the goal of safeguarding children’s health within a school environment. This form tracks immunizations against diseases such as measles, mumps, and whooping cough, emphasizing the importance of preventing outbreaks and maintaining a healthy school community. Though it is more specific in its health focus, it complements the comprehensive screenings covered by Form 3300 by ensuring another aspect of child health is monitored.

The Adolescent Well-Check Flyer, often used for older children, parallels the Form 3300's objective of early detection of health issues that could impede a student's academic and social development. By focusing on teenagers, this document addresses age-specific concerns such as mental health, nutrition, and risk behaviors, highlighting the continued need for health monitoring as children grow.

The Early Childhood Screening Record, employed in Minnesota, shares similarities with Georgia’s Form 3300, focusing on early detection of health or developmental problems in preschool-aged children. It covers vision and hearing screenings among other evaluations, ensuring children are ready to learn and succeed upon school entry. This document underscores the importance of early interventions, akin to the philosophy behind Form 3300.

The Preparticipation Physical Evaluation, widely used for school-aged athletes across the country, while not identical, serves a complementary purpose to the Form 3300 by focusing on assessing a child’s physical readiness to participate in sports. This form includes a medical history and a physical examination, with an emphasis on identifying conditions that might put the student at risk during physical activity, illustrating an aspect of child health and safety within the school setting.

The Immunization Certificate, analogous to specific sections of various state-required health forms, including the Form 3300, is pivotal in ensuring that children are vaccinated against common communicable diseases before entering public schools. By requiring proof of immunization, this document, like the Form 3300, plays a crucial role in public health and the prevention of disease outbreaks within educational settings.

Finally, the Head Start Program Health and Nutrition Screening form, part of the federal Head Start program, encompasses a broad range of screenings similar to those in Form 3300, aimed at ensuring that children from low-income families are healthy, well-nourished, and ready to learn. This document reflects a comprehensive approach to assessing child well-being, aligning with Form 3300’s objectives of identifying and addressing early any health-related issues that could impact a child's ability to succeed in school.

In essence, while each of these documents serves specific populations or focuses on particular aspects of health, they collectively underscore the importance of early health screenings and interventions for children. By identifying potential health issues before they become barriers to learning, these forms facilitate better educational outcomes and overall well-being for children.

Dos and Don'ts

When you're preparing to fill out the Georgia Department of Public Health Form 3300, it's essential to approach this task with care to ensure that all information is accurately and completely provided. This form is a critical step in ensuring your child receives the necessary screenings for vision, hearing, dental, and nutrition before enrolling in a Georgia public school for the first time. Below is a list of dos and don'ts to guide you through this process:

  • Do ensure that all screenings (vision, hearing, dental, and nutrition) are completed before you fill out the form. Each section needs to be documented properly.
  • Do verify that the screenings are conducted by qualified professionals. This could be your child’s doctor, a local health department, or other authorized individuals like a Georgia licensed optometrist for vision screening and a registered dietitian for nutrition screening.
  • Do provide complete and accurate contact information for both the parent/guardian and the screener, including daytime and evening phone numbers. This information is critical for follow-up if needed.
  • Do check the appropriate boxes that accurately describe the outcome of each screening and provide explanations whenever necessary, especially if the box for “needs further evaluation” is checked.
  • Do sign and date the form where indicated to certify the accuracy of the information provided and the completion of the screenings.
  • Don't leave any sections incomplete. An incomplete form could delay your child’s enrollment in school.
  • Don't guess or make assumptions about your child’s health status. Make sure all information reflects the results of the professional screenings.
  • Don't ignore the “needs further evaluation” box. If any of the screenings indicate that further evaluation is necessary, arrange for your child to see a professional as soon as possible.
  • Don't forget to keep a copy of the form for your records before submitting it to the school. It’s always a good idea to have a backup of important documents.

By following these guidelines, you can ensure the Form 3300 is filled out correctly and thoroughly, laying the groundwork for a smooth enrollment process for your child in the Georgia public school system. Remember, the purpose of this form and its requirements is to support the health and well-being of your child, making it an important step not to be overlooked.

Misconceptions

  • Only Certified Healthcare Professionals Can Complete the Ga 3300 Form: This is not completely accurate. While it is true that healthcare professionals like doctors, optometrists, and dentists can conduct the screenings, the Form 3300 can also be completed by trained employees of Prevent Blindness Georgia, speech-language pathologists, audiologists, registered nurses at schools, and registered dieticians. The aim is to ensure comprehensive screenings without restricting them to a specific type of healthcare provider.

  • Every Section of the Form Must Be Completed by the Same Screener: This is a misunderstanding. The Form 3300 is designed to record screenings from various professionals. A child’s vision might be screened by an optometrist, hearing by an audiologist, dental health by a dentist, and nutrition status by a registered dietician. The form accommodates input from multiple screeners, reflecting a collaborative approach to the child’s health.

  • The Form is Only Necessary for Enrollment in Public Schools: While primarily associated with public school enrolment, the importance of the Form 3300 goes beyond this requirement. It serves as a vital checkpoint for children’s health, irrespective of their education setting. While it is filed with public schools as part of the enrolment process, the screenings are beneficial for all children and can support their wellbeing in any setting.

  • Screening Results on the Ga 3300 Form Immediately Disqualify a Child from School Enrollment: This misconception can cause unnecessary worry. The purpose of Form 3300 is to identify potential health issues early on, not to serve as a barrier to education. If a section of the form indicates that further evaluation is needed, this does not prevent school enrollment. Instead, it prompts guardians to seek further professional evaluation and assistance for the identified issue.

  • BMI Information on the Form Discriminates Based on Weight: The inclusion of BMI and BMI percentile in the nutrition section is often misunderstood. These metrics are not used to stigmatize or discriminate against children based on their weight. Instead, they provide a standardized method to identify potential nutrition-related health issues. When a child’s BMI falls outside the recommended percentiles, it signals a need for further evaluation to ensure they receive proper care and guidance, supporting their overall health and wellbeing.

Key takeaways

Understanding the Georgia Department of Public Health Form 3300 is crucial for parents enrolling their child for the first time in a Georgia public school. Here are ten key takeaways to guide you through filling out and using the form effectively:

  • All children entering a Georgia public school for the first time must have a completed Form 3300 filed with the school.
  • The form covers four critical screenings: vision, hearing, dental, and nutrition, which must all be completed before the form can be filed.
  • Authorized professionals like your child's doctor, local health department, licensed optometrists, dentists, dieticians, audiologists, speech-language pathologists, and school registered nurses can conduct these screenings.
  • Vision screening requires a pass mark of 20/30 in each eye for children aged 6 and above, and 20/40 for those below 6. If corrective lenses are used, this should be indicated on the form.
  • Hearing screening includes tests at 500, 1000, 2000, and 4000 Hz with an audiometer at 20 or 25 dB. The child must pass all frequencies to avoid further evaluation.
  • Dental screenings focus on the normal appearance, the urgency of any problems, and whether professional dental care is already being received.
  • Nutrition screening evaluates a child's height, weight, and Body Mass Index (BMI) to identify if they're within the appropriate range for their age.
  • If a child's BMI percentile falls below the 5th percentile or above the 85th, further evaluation is recommended to ensure they are getting the right nutritional support.
  • In cases where further evaluation is needed for any of the screenings, parents are advised to take their child for a more detailed assessment by a professional.
  • Form 3300 is meant to be filed only once. If your child transfers to another Georgia public school, the original school will forward the Form 3300 to the new school.

Remember, completing and filing Form 3300 is an important step in ensuring your child's health and readiness for school. Should you need further clarification or assistance, your local health department or child's school can provide support.

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