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.