PHYSICAL EXAMINATION AND VISUAL EVALUATION Standard: School boards must require evidence of a physical examination and a visual evaluation within six months prior to the entrance of a child into the beginner grade or, in the case of a transfer from out of state, to any other grade of the local school. The visual evaluation must consist of testing for amblyopia, strabismus, and internal and external eye health, with testing sufficient to determine visual acuity.

ATTACHMENT 1: DHHS MINIMUM REQUIRED ANNUAL SCHOOL HEALTH SCREENINGS SCREENING by Grade or Age Level For procedural guidelines and competencies for each screening, see DHHS School Health Guidelines for Nebraska Schools. Age 3-5 yrs K 1 2 3 4 5 6 7 8 9 10 11 12 HEARING: pure tone audiometry annually X X X X X X X VISION: distance annually X X X X X X X VISION: hyperopia (near vision) X X DENTAL: inspection of teeth annually X X X X X X X **HEIGHT/WEIGHT STATUS: body mass index percentile annually annually X X X X X X X Physical Examination By physician, physician assistant, or advanced practice registered nurse X X Visual Evaluation By physician, physician assistant, advanced practice registered nurse, or optometrist. X

Additional Indications for Screening:

1. New to district at any time, with no previous screening results available.
2. Student enters the Student Assistance Process, with no recent or current screening results available.
3. Periodic screenings as specified by the student’s Individualized Education Plan (IEP)
4. Nurse concern, i.e. sudden wt. loss/gain, change in stature or appearance; parent or teacher concern; audiologist referral.
5. Unremediated concerns from previous year. Notes:
   1. The student with known hearing or vision deficits may not need periodic screenings for these conditions. This will be determined on an individual basis by the child’s Individualized Education Plan (IEP) and/or school personnel following the student.
   2. Screening results may be taken from physical examination, visual evaluation, or dental examination reports if equivalent screening results are available and documented.
   3. If parent/guardian wishes to refuse school health screening, parents/guardian must submit written statement(s) from a qualified examiner that the child has received the minimum required screenings within the past six months or the child will be screened at school.

The guide provides guidance for school nurses to implement successful screening programs.

(2) The board shall comply with the requirements of subsection (2) of section 43-2007 and shall require evidence of: (a) A physical examination by a physician, a physician assistant, or an advanced practice registered nurse, practicing under and in accordance with his or her respective certification act, within six months prior to the entrance of a child into the beginner grade and the seventh grade or, in the case of a transfer from out of state, to any other grade of the local school; and (b) a visual evaluation by a physician, a physician assistant, an advanced practice registered nurse, or an optometrist within six months prior to the entrance of a child into the beginner grade or, in the case of a transfer from out of state, to any other grade of the local school, which consists of testing for amblyopia, strabismus, and internal and external eye health, with testing sufficient to determine visual acuity, except that no such physical examination or visual evaluation shall be required of any child whose parent or guardian objects in writing. The cost of such physical examination and visual evaluation shall be borne by the parent or guardian of each child who is examined.