STUDENT MEDICAL EXAMINATIONS AND IMMUNIZATION REQUIREMENTS
680 Immunization Record (blue card)
HRS 340 Physical Form (yellow form)
1. Physical Examination by doctor
2. TB skin test results or proof of screening. Ifpositive results, must have chest x-rays done with clearance paperwork. RESULTSOF TB TEST MUST BE READ BY THE DOCTOR.
3. 5 DTP’s
4. 4 POLIO’s
5. 2 MMR’s First dose must be administered AFTER first birthday
6. 3 Hepatitis B Vaccines Minimum of two required
7. 2 VARICELLA VACCINES (Chicken Pox). If studenthad the disease, the year must be indicated on the 680 form (blue)
PERRINE HEALTH CENTER:
18255 Homestead Ave
NARANJA HEALTH CENTER
13805 SW 264 St.
305-258-6813 or 305-258-9858
PROOF OF AGE:
Must have original birth certificate or passport. If youneed to obtain a copy from the state of Florida, you may write to:
DEPARTMENT OF HEALTH AND REHABILITIVE SERVICES
DIVISION OF HEALTH AND REHABILITIVE SERVICES
DIVISION OF HEALTH – BUREAU OF VITAL STATISTICS
P.O. BOX 210
JACKSONVILLE, FL 32201
Or for faster, same day service: Vital Statistic Records Office (On HomesteadAvenue next to the Health Center)
Social Security Card: If the student has a social security number, you must bring the ORIGINAL card.
PREVIOUS SCHOOL RECORDS: Students entering grades 1-5 mustbring copies of report cards, promotion notices, or original letter fromprevious school stating current of future grade placement.
PROOF OF ADDRESS: MUST HAVE TWO OF THE FOLLOWING:
1. Most recent FPL (bottom portion)
2. Properly notarized lease agreement
3. Properly recorded warranty deed
4. Homestead exemption papers
5. If living with someone else, you can bring anytype of official correspondence, driver’s license, or anything personal withthe parent’s name.