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Clarksville Montgomery County School System HEALTH SERVICES HEARING REFERRAL Student Name ___Date ___Grade ___Teacher ___Dear Parent: Your child recently participated in a hearing screening mandated
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Begin by providing your personal information such as name, date of birth, and contact information.
02
Answer all the questions accurately regarding your current health status and any symptoms you may be experiencing.
03
If you have been in contact with someone who has tested positive for a contagious disease, make sure to disclose this information.
04
Once you have completed all the necessary fields, review your answers for accuracy before submitting the form.

Who needs student health screening and?

01
Students who are attending in-person classes or participating in on-campus activities typically need to complete a student health screening.
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Student health screening is a process that assesses students' health status and identifies potential health issues.
School administrators or healthcare professionals are required to file student health screening.
Student health screening can be filled out online through a designated portal or submitted in person at the school's health office.
The purpose of student health screening is to ensure the overall well-being and health of students, as well as to detect any underlying health concerns.
Student health screening must report basic health information such as vaccination records, medical history, and any ongoing health conditions.
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