If parent/caregiver has questions regarding the form, a contact number for referral/follow-up should be given. Parent/caregiver is given the forms to complete and answers are reviewed and flagged if there is a significant history of conditions, syndromes, risk factors for vision conditions, or concerning behaviors reported. Diseases and Conditions associated with vision and eye abnormalities.Teacher and Child Vision Prescreening Worksheet for educational settings as indicated.Child and Family Vision Risk Assessment and History for C&TC clinic settings and other screening settings as indicated.In the C&TC clinic setting a positive risk factor should be reviewed by the medical provider. Refer to Assessment Tools on the Vision Screening Forms, Tools and Materials webpage. * If needed caregiver or provider can review a list of Diseases and Conditions associated with vision and eye abnormalitiesĬan be performed by screeners who have received the recommended training by the Minnesota Department of Health or equivalent.
Risk factors that can indicate potential vision conditions include: Refer to Child and Family Vision History and Risk Assessment form for a succinct list of concerns and questions that the parent or caregiver can respond to.įactors that are noted to potentially change in the interim such as care giver concerns or observations should be reviewed at subsequent C&TC well child visits or screenings. Identify a child/family history of any medical condition that may be associated with eye disorders.įor initial interviews review risk factors that can indicate potential vision conditions recognized by the American Academy of Pediatrics and National Center for Children's Vision and Eye Health at Prevent Blindness: (), and the parent /caregiver's/ teacher's observation of their child's complaints or unusual visual behavior that may indicate a vision concern. One month through 20 years: most important to fill out before the child can reliably be screened with visual acuity charts typically at three years of age. Download: Child and Family Vision History Taking (PDF)
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