R384-201-10. Symptoms Questionnaire

  (1) The UDOH will provide schools a vision symptoms questionnaire that includes questions for classroom teachers to potentially identify eye focusing or tracking problems as well as convergence insufficiency. The UDOH will update the questionnaire as needed.

  (2) For students who fail to achieve benchmark status on the benchmark reading assessment in grades 1-3:

  (a) The LEA shall notify the student's teacher within 30 calendar days of student performance on the benchmark reading assessment.

  (b) Teachers must complete the vision symptoms questionnaire within 45 calendar days of the administration of the assessment and submit to the school nurse.

  (c) Teachers need only complete the vision symptoms questionnaire once per school year.

  (d) School nurses or other approved tier 2 vision screeners shall use the vision symptoms questionnaire to perform a secondary assessment and/or refer to an eye care professional.

  (3) For students who are being referred to special education for a suspected disability affected by vision difficulties:

  (a) Teachers must complete the vision symptoms questionnaire and submit to the school nurse.

  (b) School nurses or other approved tier 2 vision screeners shall use the vision symptoms questionnaire to perform a secondary assessment and/or refer to an eye care professional.

  (4) For students who are being referred by parent or guardian for vision concern:

  (a) Parent or guardian should complete the vision symptoms questionnaire and submit to the school nurse.

  (b) School nurses or other approved tier 2 vision screeners shall use the vision symptoms questionnaire to perform a secondary assessment and/or refer to an eye care professional.