Kentucky boards of education require a preventive health care examination within 12 months before a child first enters public school and within one year before entry to sixth grade. Clinicians meet this two-page form at kindergarten and sixth grade physicals; it gives the school screening results, exam findings, conditions needing emergency action and any activity restrictions.
The parent completes the identifying information. A physician, APRN, PA or EPSDT provider completes the history, screening, examination and recommendation sections and signs page two.
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Preventative Health Care Examination Form
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Under 702 KAR 1:160, a child first entering a Kentucky public school needs the exam within twelve months before initial admission, and again within one year before entering sixth grade. Local school boards may extend the time by up to two months.
No. The form states that immunizations are reported on the Immunization Certificate form, EPID 230. The provider records allergies, daily school medications and significant history, but vaccine dates go on the separate certificate.
The checklist covers school readiness, mental health, nutrition and physical activity (including 60 minutes of exercise a day), oral health and safety topics such as helmets, swimming, smoke detectors, guns, sun and vehicle restraints. The provider marks what was discussed or handed out.