Guidelines for Vision Screening in Missouri Schools
APPENDIX C: Sample Forms
Report To Parents
Letter Template For Report To Parents
Checklist For Vision
Checklist For Vision including Observation and History, and Signs or Symptoms of Eye Problems
Referral Tracking System
Referral Tracking System (Sample)
School Vision Referral
School Vision Referral Template
HIPAA Compliant Authorization
HIPAA Compliant Authorization Exchange of Health & Education Information
School Vision Screening Form
School Vision Screening Form Including School Functional Vision Assessment Form