Texas requires every child to have an eye examination or an approved vision screening before or within 120 days after entering a public or private preschool or school, licensed child care center or child care home. The M-60 certificate records the screening results and any referral, and clinicians see it when a child who failed a screen is sent for evaluation.
A certified vision screener completes the screening sections and signs the screening certification. The parent may sign the waiver of referral, naming the eye care specialist already seeing the child.
Download the current version from the source each time; forms change without notice.
Certificate of Record for Vision Screen and/or Eye Examination
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The form says the Vision and Hearing Screening Program requires every child to have an eye examination or an approved vision screening test before, or within 120 days after, entering a Texas public or private preschool or school, licensed child care center or child care home.
If a child is already being seen by an eye care specialist for the problem found, the parent signs the waiver of referral and writes in the doctor's name. This records that the child is under care instead of sending a new referral.
The M-60 records the referral reason, such as distance acuity, automated device, light reflex or cover test results, or a parent or doctor request. The parent notice says the child then needs evaluation by their primary care provider to determine whether there is a vision problem.