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Updated Health Screening Form

Posted on 08/26/2016 at 12:00 AM by MaryAnn Strawhacker

Welcome Back School Nurses!

Thanks to the astute new school nurses taking the NSN Moodle class! Over the years, they pointed out areas of the screening form that were confusing. Also AEA process have changed since the form was originally developed. Because of this some minor changes have been made on the form. To best understand  this explanation, please download a copy of the new form found to the right of this blog post and use it for reference.


1. In the top right hand of the form, "Disability Suspect" (DS) was added to the list of choices under the "Purpose for Screening". When a team is planning for a DS meeting and the RN determines that the screening is positive, this alerts the team. Should the team decide to conduct a full and individual evaluation for special education, the health domain should be selected, and  parental consent obtained. If the RN determines that health is not a factor then box H is checked and health will not be included in the special education evaluation.

2. Scroll to the bottom of the page and note that before the letters F-H, there is now a header that says, "Results". The entire reason for screening health (for you as a registered school nurse) is to give your professional opinion as to whether or not this student may have a health condition that may interfere with learning or access to education.  The bar here is low. If you are unsure of the effects or need to collect any new  health information for DS or a special education student, error on the side of positive and conduct the evaluation.

As in the past, if you do not have a purpose for screening checked, return the form to the requester and get this information. You will only write a full and individual evaluation report for a student being evaluated for special education. If the screening form is used for Section 504 or a building level team, you will complete A-E on this form. When used for special education, the box you select under the results section is the most important part of the form. For DS or special education, you can actually disclose too much in sections A-E. Keep it brief and remember that parental signed consent is required to collect new information for special education. Prompts were also added to F-H to help both nurses and teams.

We are hoping that these two clarifications will help improved the process for health evaluations. If you receive an old screening form, please copy the top section onto a new form and return it to the requester. The new form has "2016 Revised AEA 11" in the lower right hand corner.

Have a great school year!


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