School Health Forms and Action Plans

Child care provider, private/parochial school, Head Start program, local health departments, day or residential camp, or others:
If you choose to utilize the Commonwealth of Virginia School Entrance Health Form MCH 213G, please download and make copies as needed.

Parents enrolling their child in public schools: download and print the Commonwealth of Virginia School Entrance Health Form MCH 213G.

Health care providers: direct parents/guardians to download and print the Commonwealth of Virginia School Entrance Health Form MCH 213G as needed.

Commonwealth of Virginia School Entrance Health Form MCH 213G (reviewed 03/2014) (Instructions)

Commonwealth of Virginia School Entrance Health Online Fillable Form (MCH213G)

Certificate of Religious Exemption

Action Plans and Checklists

CDC Concussion Signs and Symptoms Checklist

Epilepsy Foundation Seizure Action Plan ( pdf )

Food Allergy Research & Education (FARE) Food Allergy Action Plan ( English | Spanish )

Virginia Asthma Coalition Asthma Action Plan ( pdf )

Virginia Diabetes Council Medical Management Plan and Protocol Supplement ( pdf )