Tip for State-specific (e.g., VA MCH213G)

Complete physical exams and immunizations before the school deadline to avoid delays in enrollment

Tip for State-specific (e.g., VA MCH213G)

If your child has a chronic condition (asthma, diabetes, epilepsy, allergies), ask about a 504 Plan for school accommodations

Tip for State-specific (e.g., VA MCH213G)

Medication authorization forms typically require both the physician's signature and a parent's signature

Maternal & PediatricmoderateDoctor signature required

School Entrance Health Form

State-specific (e.g., VA MCH213G) · State Departments of Health/Education

Required for school entry. Includes immunization records, health history, physical examination, and developmental screening. Must be completed no earlier than one year before school entry.

Form Details

Total fields: 45
Auto-fillable: 30 (67%)
Time without BeneFill: 30 minutes
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Filled by: both
Frequency: one time
State-specific: Yes — form may vary by state

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Where to Submit This Form

📬

Return to your child's school nurse or school office

🏢

Hand-deliver to the school nurse or front office

Filing Deadline

Typically due before the start of the school year or within 30 days of enrollment. Medication administration forms may be needed at any time.

Required Attachments

📎 Completed school health form signed by the child's physician or licensed healthcare provider
📎 Current immunization records
📎 Medication administration authorization (if the child needs medication at school)
📎 Allergy or anaphylaxis action plan (if applicable)
📎 Asthma action plan or diabetes management plan (if applicable)

Processing Time

Processed by the school nurse, typically within a few days of receipt.

What Happens Next

The school nurse will review the form and develop an appropriate care plan. If your child has a chronic condition, the nurse may request a meeting to develop a Section 504 plan or Individual Health Plan (IHP).

Tips for This Form

✓ Complete physical exams and immunizations before the school deadline to avoid delays in enrollment
✓ If your child has a chronic condition (asthma, diabetes, epilepsy, allergies), ask about a 504 Plan for school accommodations
✓ Medication authorization forms typically require both the physician's signature and a parent's signature
✓ Update the school immediately if your child's health conditions or medications change during the school year

More Maternal & Pediatric Forms

WIC Application

State-specific · USDA Food and Nutrition Service (state-administered)

Application for WIC nutrition assistance providing education, breastfeeding support, and benefits for healthy foods. Requires proof of identity, address, income (or Medicaid/SNAP/TANF participation), and a health screening.

WIC Medical Documentation / Nutrition Risk Form

State-specific · State WIC agencies

Medical documentation of nutrition risk factors qualifying an individual for WIC, such as anemia, underweight, or high-risk pregnancy.

CHIP Application

State-specific / Healthcare.gov · State CHIP agencies

Application for Children's Health Insurance Program for families with income too high for Medicaid but too low for private coverage. Uses MAGI-based financial eligibility. Children must be uninsured.

Immunization Record / Certificate of Immunization

State-specific · State Departments of Health

Official record of required childhood vaccinations for school enrollment. Exemption forms (medical, religious, philosophical) vary by state.

Medication Administration Authorization (School)

District-specific · School districts

Authorization for school nurse or designee to administer prescribed medication during school hours.

Section 504 Plan (Medical)

District-specific · School districts

Accommodation plan for students with health conditions (diabetes, allergies, asthma, ADHD) that impact school participation. Includes a medical management plan and emergency action plan.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Departments of Health/Education or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.