Kentucky law (KRS 156.160) requires proof of a vision examination by an optometrist or ophthalmologist for children aged three to six in their first year of public school, public preschool or Head Start. This one-page form carries the case history, acuity, exam findings, diagnosis and recommendations back to the school, which must receive it by January 1 of that first year.
The parent completes the identifying information and date of enrollment. The optometrist or ophthalmologist completes the case history, examination, diagnosis and recommendations and signs the form.
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Kentucky Eye Examination Form for School Entry
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KRS 156.160 calls for a vision examination by an optometrist or ophthalmologist, and the signature line is for those professionals. The vision screening recorded on the separate preventive health care examination form (KDESHS002) is a different requirement and does not replace this exam.
The evidence must be submitted to the school no later than January 1 of the first year that a three, four, five or six year old child is enrolled in public school, public preschool or a Head Start program.
The case history covers the exam date, ocular history, medical history, drug allergies and family history of amblyopia, strabismus, glaucoma and diabetes, plus other pertinent information. Each item is marked normal or positive with details.