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Virginia MCH 213G School Entrance Health Form

Virginia law (Code of Virginia 22.1-270) requires children to be immunized and to have a comprehensive physical examination before entering public kindergarten or elementary school. The provider completes Part II, the Certification of Immunization, and Part III, the physical examination report, giving the school screenings, findings and any care plans or restrictions the child needs.

Who completes it

The parent completes Part I, the health information form. A physician, nurse practitioner or physician assistant completes and signs Part III; Part II may be signed by a physician or designee, registered nurse or health department official.

Submitting and payment

How to submit it
The completed form is returned to the parent, who submits it to the school; the form must be completed no earlier than one year before school entry.
Who pays
The form sets no fee; Part I asks whether the child has FAMIS Plus (Medicaid), FAMIS or private insurance but does not address payment.

Good to know

  • A signed or stamped immunization record may be attached instead of writing dates in Part II, but the certification must still be signed and dated.
  • Conditional enrollment requires at least one dose of each required vaccine and a plan to finish within 90 calendar days, or 180 days for hepatitis B.
  • Part III records TB risk screening, developmental, hearing, vision and dental screens, and EPSDT blood lead and hematocrit or hemoglobin results required for Head Start.
  • The fillable 6/2024 version includes an electronic signature checkbox; Spanish and several other languages are available.

Get the official form

Download the current version from the source each time; forms change without notice.

Commonwealth of Virginia School Entrance Health Form

Mancomunidad de Virginia Formulario de Salud Para El Ingreso Escolar

Official pagePDFVersión en español

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

How recent must the Virginia school entrance physical be?

Part III states the exam must be done no longer than one year before entry into kindergarten or elementary school, and the form must be completed no earlier than one year before the child's entry.

How do medical and religious exemptions work on MCH 213G?

A physician, NP or PA certifies a medical exemption in Part II, naming the contraindicated vaccines and whether it is permanent or temporary. A religious exemption needs a separate affidavit, the Certificate of Religious Exemption (CRE-1), submitted to the school's admitting official.

Is the Virginia School Entrance Health Form available in Spanish?

Yes. VDH posts a Spanish version, Formulario de Salud Para El Ingreso Escolar, and the form is also available in languages including Arabic, Chinese, Dari, Korean, Pashto, Russian, Swahili, Tagalog, Ukrainian and Vietnamese.