School Nurse Procedure Manual - The School District of Philadelphia

III.SCHOOL DISTRICT OF PHILADELPHIASCHOOL NURSE PROCEDURE MANUALCriteria for referralA. Kindergarten through Gr. 3: vision that is no less than 20/40-3 in one or both eyes.B. Grade 4 and up: vision that is no less than 20/30-3 in one or both eyes.C. In any grade, when the difference between both eyes is two lines or more, the student has failed.This is true even if the visual acuity for each eye is within the passing range. For example, astudent who reads 20/20 in the right eye,, and 20/30 in the left eye has failed the vision screening.IV. ReferralA. Screen initial failures a second time before sending Vision Screening Referral.B. Initiate a Vision Screening Referral for all students who fail screening.C. Explain use of referral form to student and/or parent/guardian.D. When referral or follow-up indicate need, Public School Health Fund vision appointments can bemade for public school students.V. Complete documentation on the student’s record.A. The HIS, screen H3 in Main Menu #2, Health Inquiry and Maintenance, is to be used unless it isnot available in the school.B. In the event that the HIS is not available, document on the MEH 3, Student Health Record, and onthe Vision Screening Worksheet or Program Control Sheet.VI. When a child’s corrected vision is 20/70 or less in the better eye the student is considered visuallyimpaired. Follow procedure for Students with Special Needs/Visually Impaired.VII.Rescreen student with new glasses to verify a correction as reported. Document this screening.September 1, 2002 Page 32