B. Certain children should bypass vision screening and be referred directly to an eye specialist for a comprehensive examination because these children have a higher rate of vision problems. The school nurse may determine which children should be referred directly. Some reasons for bypass may include:

• i. readily recognized eye abnormalities such as, but not limited to, strabismus or ptosis;

• ii. a known diagnosis of a neurodevelopmental disorder such as hearing impairment, cerebral palsy, autism spectrum disorders, or speech delay;

• iii. systemic diseases known to have associated eye disorders such as diabetes and juvenile rheumatoid arthritis

G. A student will be considered to fail and will need to be referred for further evaluation by a health care provider when the student is unable to hear any of the frequencies in either ear at 25dB.

H. Students who fail the hearing screening will be referred to their parents and provided with a referral form to bring to their health care provider.

v. Referral guidelines

• 1. Age 3, unable to correctly identify at least 3 of 5 optotypes on 20/50 line;
• 2. Age 4-5, unable to correctly identify 3 of 5 optotypes on the 20/40 line;
• 3. Age 6 and older, unable to correctly identify at least 3 of 5 optotypes on the 20/32 line;
• 4. If using a full threshold screening method, children who have a 2-line difference between the eyes, even in the passing lines, are to be referred for an eye exam.

The school board shall appoint appropriate school staff to inform the parent of a student suffering from a suspected disease or defect based on the screening results.