The Georgia Department of Public Health Form 3300 is a vital document known as the Certificate of Vision, Hearing, Dental, and Nutrition Screening. This form is essential for parents or guardians enrolling their child in a Georgia public school for the first time, ensuring that the child receives necessary health screenings. To get started on this important process, click the button below to fill out the form.
When enrolling a child in a Georgia public school for the first time, parents or guardians must complete and submit the GA 3300 form, also known as the Certificate of Vision, Hearing, Dental, and Nutrition Screening. This important document ensures that children receive necessary screenings for potential health issues in these four critical areas. The form requires detailed information about the child, including their name, date of birth, and home address, as well as contact information for the parent or guardian. Each screening—vision, hearing, dental, and nutrition—must be conducted by qualified professionals, such as a physician, local health department staff, or school registered nurses. The results are documented on the form, indicating whether the child passed the screenings or needs further evaluation. The inclusion of Body Mass Index (BMI) and its percentile helps assess the child’s nutritional health. If any area indicates a need for further evaluation, it is crucial for parents to seek additional support. Understanding the GA 3300 form is essential for ensuring that children start their educational journey with a solid foundation of health and wellness.
Georgia Department of Public Health
Form 3300
Certiicate of Vision, Hearing, Dental, and Nutrition Screening
PLEASE SEE THE INSTRUCTIONS
ON THE BACK OF THIS FORM
FILE THIS FORM WITH THE SCHOOL WHEN YOUR CHILD IS FIRST ENROLLED IN A GEORGIA PUBLIC SCHOOL
SCREENER CONTACT INFORMATION IS REQUIRED
Parent/ Guardian Name:_______________________________________
irst
middle
last
Parent/ Guardian Contact Information:
Daytime phone number:_____________________________________________________________
Evening phone number:_____________________________________________________________
Cell phone number:_________________________________________________________________
Child’s Name:__________________________________________________
Date of Birth: _____/_____/_____
Gender: Male Female
Child’s Home Address:
____________________________________________________________________________________
street
city
state
zip code
county
VISION
Unable to screen (explain why below)
Uses corrective lenses
Worn for testing
Passed (20/30 in each eye for age 6 and above, 20/40 in each eye for below age 6)
Needs further evaluation
Under professional care (explain below)
Screening completed by:
Physician
Local Health Department
Optometrist
“Prevent Blindness Georgia” employee
School Registered Nurse
___________________________________
Screener’s Signature Date
I certify that this child has received the above screening.
Contact Information:
HEARING
Uses hearing aid / assistive device
Passed at 500, 1000, 2000, and 4000 Hz with audiometer at 20 or 25 dB
Audiologist
Speech-Language Pathologist
DENTAL
Normal appearance
Emergency problem observed
Dentist
Local Health Department Registered Nurse
Registered Dental Hygienist
NUTRITION
Height: ___________
Weight: ___________
BMI: _____________
BMI%: ___________
5th to 84th percentile - Appropriate for age
< 5th percentile - Needs further evaluation
≥ 85th percentile - Needs further evaluation
Registered Dietician
FOR SCHOOL SYSTEM ONLY
Follow up for further evaluation
1st attempt
2nd attempt
Actions reported (if any)
Vision
Hearing
Dental
Nutrition
Student support services initiated on:
Screeners’ Comments:
DPH FORM 3300 REV. 2013
Georgia Department of Public Health Form 3300
Certificate of Vision, Hearing, Dental, and Nutrition Screening
Who is required to file this Form 3300? The parent or guardian of a child who is being admitted for the first time to a public school in Georgia must file a completed Form 3300 with the school when the child is enrolled.
What is the purpose of Form 3300? Form 3300 is intended to make sure that every child in Georgia is screened for possible problems with their vision, hearing, teeth and nutrition. The earlier these problems are detected, the earlier parents can seek professional help for the child.
What screenings are required? Four different screenings are required: vision, hearing, dental, and nutrition. All four screenings must be conducted and reported on the form before it can be filed with the school.
Who can conduct the screenings? Your child’s doctor is authorized to conduct all four screenings, as is your local health department. In addition, the vision screening can be conducted by a Georgia licensed optometrist, an employee of Prevent Blindness Georgia trained to conduct vision screening, or a school registered nurse; the hearing screening can be conducted by a Georgia licensed speech-language pathologist or audiologist, or a school registered nurse; the dental screening can be conducted by a Georgia licensed dentist, dental hygienist, or a school registered nurse; and the nutrition screening can be conducted by a Georgia licensed dietician or a school registered nurse. It is not necessary that the same person conduct all four screenings.
What does “BMI” and “BMI%” mean? “BMI” means “body mass index.” BMI is a way to describe how
much a child weighs in relation to height. “BMI percentile” is a way to compare the child’s body mass index to the body mass index of a healthy child. If the child’s BMI is less than 5% or more than 84% of what is appropriate for his or her age
and height, then the child should be taken to a doctor or dietician for a more detailed evaluation. For more information, visit
the Centers for Disease Control and Prevention website on child and teen BMI at: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
What should a parent do if the “needs further evaluation” box is checked? “Needs further evaluation”
means that the child may have a problem. If the “needs further evaluation” box is checked, then the parent should
take the child to a professional for a more detailed evaluation. Your doctor or local health department may be able to help, or recommend someone who can help.
What if a Form 3300 was previously filed for the child at another school? It is only necessary to file the Form 3300 once. If the Form 3300 is filed at the child’s first school, and the child later transfers to another school, then the original school is
required to forward the Form 3300 to the new school.
Completing the Georgia Form 3300 is an essential step when enrolling your child in a public school for the first time. This form collects important information regarding your child's vision, hearing, dental, and nutritional health. To ensure that you fill out the form correctly, follow these steps carefully.
After submitting the form, the school will review the information and may follow up if any screenings indicate a need for further evaluation. It’s important to keep a copy for your records in case it is needed later. This proactive approach helps ensure your child's health and well-being as they begin their educational journey.
The responsibility to file Form 3300 falls on the parent or guardian of a child who is enrolling in a public school in Georgia for the first time. This form must be completed and submitted to the school during the enrollment process. It serves as an essential document to ensure that the child has undergone the necessary health screenings.
Form 3300 is designed to guarantee that every child in Georgia is screened for potential issues related to vision, hearing, dental health, and nutrition. Early detection of these problems is crucial. By identifying issues sooner rather than later, parents can seek appropriate professional assistance for their child, ensuring better health outcomes.
Four specific screenings are mandated: vision, hearing, dental, and nutrition. Each of these screenings must be conducted and documented on the form before submission to the school. This comprehensive approach helps to assess various aspects of a child's health, promoting overall well-being.
Various qualified professionals can perform the screenings. A child's doctor or local health department is authorized for all four screenings. Additionally, specific professionals can conduct individual screenings:
It is important to note that the same person does not need to conduct all four screenings, allowing for flexibility in meeting the requirements.
Filling out the GA 3300 form can be straightforward, but many people make common mistakes that can lead to delays or complications in their child's enrollment. One frequent error is failing to provide complete contact information for the parent or guardian. This section is crucial, as schools need to reach parents for any follow-up regarding screenings or additional information. Missing phone numbers or incomplete names can hinder communication.
Another mistake often seen is neglecting to check all relevant boxes for the screenings. Parents might forget to indicate if their child passed the vision or hearing tests, or they may overlook the option for "needs further evaluation." This oversight can result in the school not having a complete understanding of the child's health needs, which is essential for their educational support.
Additionally, some individuals do not ensure that the screenings are conducted by the appropriate professionals. Each screening section specifies who is qualified to perform the evaluations. If the screenings are completed by someone not authorized, the form may be deemed invalid. Parents should verify that the screener’s qualifications align with the requirements outlined on the form.
Another common issue is the omission of explanations when a box indicating "unable to screen" or "under professional care" is checked. It is important to provide context in these cases. Without explanations, the school may not fully understand the circumstances surrounding the child's health, which could impact their support services.
Lastly, many people forget to sign and date the form. This step is vital, as it certifies that the information provided is accurate and that the screenings have been completed. Without a signature, the form cannot be processed, leading to unnecessary delays in the child's enrollment. Ensuring all sections are filled out completely and accurately can help avoid these common pitfalls.
The Georgia Department of Public Health Form 3300 is a crucial document for parents enrolling their child in a public school for the first time. It ensures that children receive necessary screenings for vision, hearing, dental health, and nutrition. Alongside this form, several other documents may be required or helpful in the enrollment process. Here’s a brief overview of those documents:
Gathering these documents can streamline the enrollment process and help ensure that your child receives the necessary support and services from the very beginning of their educational journey. Being prepared with the right paperwork can make a significant difference in the transition to school.
The GA 3300 form serves an essential role in ensuring children's health screenings are documented when they enroll in public schools in Georgia. Several other documents share similarities with the GA 3300 form, primarily in their purpose of documenting health and wellness information for children. Here are six such documents:
When filling out the Georgia Form 3300, there are several important dos and don’ts to keep in mind. Following these guidelines can help ensure that the form is completed accurately and efficiently.
Understanding the GA 3300 form is crucial for parents enrolling their child in a Georgia public school. However, several misconceptions can lead to confusion. Here are six common misconceptions about the GA 3300 form, along with clarifications:
Being aware of these misconceptions can help ensure that parents complete the GA 3300 form correctly and on time, facilitating a smoother enrollment process for their child.
Filling out the Georgia Department of Public Health Form 3300 is an important step for parents enrolling their child in a public school for the first time. Here are key takeaways regarding the form: