Certificate Of Vision Screening Form (Page 2 of 2) in pdf

Certificate Of Vision Screening Form Page 2

Iowa Department of Public Health

Child Vision Screening

1. Parents or guardians need to make sure their child has a vision screening at

least once before starting kindergarten and again before starting 3

Grade.

2. Kindergarten Screenings: A screening will be counted if it is done no earlier

than 1 year before and no later than 6 months after school starts.

3. 3rd Grade Screenings: A screening will be counted if it is done no earlier than 1

year before and no later than 6 months after school starts.

4. The requirement for a child vision screening will count by any of the

following:

a. A vision screening or comprehensive eye exam by an eye doctor

(ophthalmologist or optometrist).

b. A vision screening conducted at a doctor’s office, a free clinic, a child

care center, a local public health department, a public or accredited

nonpublic school, or a community-based organization or by an advanced

registered nurse practitioner or physician assistant.

c. A vision screening done by Prevent Blindness Iowa volunteers or Iowa

KidSight and Lion’s Club Volunteers.

5. The child vision screening requirement does not apply if the child vision

screening conflicts with a parent’s or guardian’s genuine and sincere religious

belief.

6. A child will not be withheld from school because a parent or guardian did not

provide proof that the child received a vision screening.

Please direct questions regarding vision screening to:

Iowa Department of Public Health - Bureau of Family Health

321 E 12th Street - Des Moines, IA 50319

FAX 515-725-1760 - Phone 800-383-3826

Certificate Of Vision Screening Form Page 2