This is an online listing of forms maintained by the department of human services. Examination form dh 3040 is the acceptable form and is in circulation in physicians offices and the county health units. Florida form 3040 fill out and sign printable pdf template. Florida school entry health requirements school entry health examination school physical form dh 3040 physical exam must have been performed within 12 months prior to registration florida certificate of immunization immunization record form dh 680 must be used to document immunizations required for entry and attendance in florida. December 2014 department of the treasury internal revenue service request for taxpayer identification number and certification give form school physical form florida the original completed dh 3040 form should be given to the parent to take to the school to provide information and to document that this requirement is. The child named above has had a complete history and physical exam on the. State of florida school entry health exam health first network. Florida department of health completing the school entry health exam form dh3040chp0720 general information purpose. The advanced tools of the editor will direct you through the editable pdf template. It must be completed by a health care provider such as a chiropractic physician chapter 460, chiropractic medicine, licensed to perform physical examinations. State of florida page 1 of 2 school entry health exam.
The exam record should be taken to the school upon enrollment. State of florida school entry health exam to parentguardian. Directions for completing the school entry health exam form page 1. Immunization form dh680 proof of updated shot record. Page 1 of 2 state of florida school entry health exam. A copy of the front and back of the completed form may be retained in the childs medical file kept by the health care provider. If the child has had a physical within the last year, a copy can be taken to the. The school health physical exam form, dh 3040, was developed as the school entry physical exam record. School entry physical walton county school district. Enter your official identification and contact details. The child named above has had a complete history and physical exam on the following date. The school entry health exam has been designed to meet the requirements for the school entry health examination, as mandated by s.
School physical examination for entry into florida schools. Forms listed are in the portable document format pdf. State law for school entry requires a health examination by a legally qualified professional. Fill out, securely sign, print or email your dh 3040 form instantly with signnow. State law for school entry requires a health examination by. Guide for completing the school entry health exam dh 3040 form. The original completed dh 3040 form should be given to the parent to take to the school to provide information and to document that this requirement is met. Please complete and sign part i childs medical history. Historically, it has been the school health office position that the. The way to complete the online florida form 3040 on the internet. Elite preparatory academy application and checklist. Dh 3040, 602 obsoletes previous editions which may not be used stock number. Although a specific form is not required, it is recommended that floridas standardized school entry exam form dh 3040 be used to document completion of a physical examination. The health history is to be filled in by the parent or interviewer in the providers office.