Article 18.
Health Assessments for Children in the Public Schools.
§ 130A‑440.  (Applicable to children enrolling in the public schools for the first time before the 2016‑2017 school year) Health assessment required.
(a)	Every child in this State entering kindergarten in the public schools shall receive a health assessment. The health assessment shall be made no more than 12 months prior to the date of school entry. No child shall attend kindergarten unless a health assessment transmittal form, developed pursuant to G.S. 130A‑441, indicating that the child has received the health assessment required by this section, is presented to the school principal. The medical provider, or the parent, guardian, or person in loco parentis, must present a completed health assessment transmittal form to the principal of the school on or before the child's first day of attendance. If a health assessment transmittal form is not presented on or before the first day, the principal shall present a notice of deficiency to the parent, guardian, or responsible person. The parent, guardian, or responsible person shall have 30 calendar days from the first day of attendance to present the required health assessment transmittal form for the child. Upon termination of 30 calendar days, the principal shall not permit the child to attend the school until the required health assessment transmittal form has been presented.
(b)	A health assessment shall include a medical history and physical examination with screening for vision and hearing and, if appropriate, testing for anemia and tuberculosis. Vision screening shall be conducted in accordance with G.S. 130A‑440.1. The health assessment may also include dental screening and developmental screening for cognition, language, and motor function. The developmental screening of cognition and language abilities may be conducted in accordance with G.S. 115C‑83.5(a).
(c)	The health assessment shall be conducted by a physician licensed to practice medicine, a physician's assistant as defined in G.S. 90‑18.1(a), a certified nurse practitioner, or a public health nurse meeting the Department's Standards for Early Periodic Screening, Diagnosis, and Treatment Screening.
(d)	This Article shall not apply to children entering kindergarten in private church schools, schools of religious charter, or qualified nonpublic schools, regulated by Article 39 of Chapter 115C of the General Statutes.  (1985 (Reg. Sess., 1986), c. 1017, s. 1; 1987, c. 114, s. 1; 1989, c. 727, s. 155; 1993, c. 124, s. 1; 1995, c. 123, s. 10; 2006‑240, s. 1(b); 2012‑142, s. 7A.1(h).)

§ 130A‑440.  (Applicable to children enrolling in the public schools for the first time beginning with the 2016‑2017 school year) Health assessment required.
(a)	Every parent, guardian, or person standing in loco parentis shall submit proof of a health assessment for each child in this State who is presented for admission into kindergarten or a higher grade in the public schools for the first time. The health assessment shall be made no more than 12 months prior to the date the child would have first been eligible for initial entry into the public schools. Within 30 calendar days of a child's first day of attendance in the public schools, a health assessment transmittal form, developed pursuant to G.S. 130A‑441, indicating that the child has received the health assessment required by this section, shall be presented to the school principal. The only health assessment transmittal form utilized by public schools shall be the form developed pursuant to G.S. 130A‑441. A completed health assessment transmittal form shall be presented to the principal of the school by either (i) the parent, guardian, or person standing in loco parentis or (ii) the health care provider specified in G.S. 130A‑440(c), if authorized in writing by the parent, guardian, or person standing in loco parentis. At the time of enrollment, the parent, guardian, or person standing in loco parentis shall be advised that a health assessment transmittal form is needed on or before the child's first day of attendance. If a health assessment transmittal form is not presented on or before the child's first day of attendance, the principal shall present a notice of deficiency to the parent, guardian, or person standing in loco parentis. The notice of deficiency shall include at least the following information: (i) the health assessment transmittal form must be submitted to the principal within 30 calendar days of the child's first day of attendance or the child will not be permitted to attend school until the form is submitted and (ii) an explanation for how the child may make up work missed in accordance with G.S. 115C‑390.2(l). The parent, guardian, or person standing in loco parentis shall have 30 calendar days from the first day of attendance to present the required health assessment transmittal form for the child. Upon termination of 30 calendar days, the principal shall not permit the child to attend the school until the required health assessment transmittal form has been presented. A child shall not be suspended for absences accrued for failure to present the required health assessment transmittal form upon the termination of 30 calendar days, and the child shall be allowed to make up work missed in accordance with G.S. 115C‑390.2(l). It shall be noted in the child's official school record when the health assessment transmittal form has been received.
(b)	A health assessment shall include a medical history and physical examination with screening for vision and hearing and, if appropriate, testing for anemia and tuberculosis. Vision screening shall be conducted in accordance with G.S. 130A‑440.1. The health assessment may also include dental screening and developmental screening for cognition, language, and motor function. The developmental screening of cognition and language abilities may be conducted in accordance with G.S. 115C‑83.5(a).
(c)	The health assessment shall be conducted by a physician licensed to practice medicine, a physician's assistant as defined in G.S. 90‑18.1(a), a certified nurse practitioner, or a public health nurse meeting the Department's Standards for Early Periodic Screening, Diagnosis, and Treatment Screening.
(d)	This Article shall not apply to children entering private church schools, schools of religious charter, or qualified nonpublic schools, regulated by Article 39 of Chapter 115C of the General Statutes.
(e)	As used in this section, "parent, guardian, or person standing in loco parentis" means parent, legal guardian, legal custodian, and caregiver adult, as those terms are used in G.S. 115C‑366. (1985 (Reg. Sess., 1986), c. 1017, s. 1; 1987, c. 114, s. 1; 1989, c. 727, s. 155; 1993, c. 124, s. 1; 1995, c. 123, s. 10; 2006‑240, s. 1(b); 2012‑142, s. 7A.1(h); 2015‑222, s. 2.)

§ 130A‑440.1.  Early Childhood Vision Care.
(a)	Vision Screening Required for Children Entering Kindergarten. – Every child in this State entering kindergarten in the public schools shall obtain vision screening. Within 180 days of the start of the school year, the parent of the child shall present to the school principal or the principal's designee certification that the child has, within the past 12 months, obtained vision screening conducted by a licensed physician, optometrist, physician assistant, nurse practitioner, registered nurse, orthoptist, or a vision screener certified by Prevent Blindness North Carolina, or a comprehensive eye examination performed by an ophthalmologist or optometrist. The health assessment transmittal form required pursuant to G.S. 130A‑440 qualifies as certification that the child has obtained the required vision screening. All providers conducting vision screening shall provide each parent in writing the results of the vision screening on forms bearing the signature of the provider. The provider shall also orally communicate this information to the parent and shall take reasonable steps to ensure that the parent understands the information communicated. In the instance where a child enters the first grade without having been enrolled in a kindergarten program requiring a vision screening, the requirements for vision screening under this subsection apply.
(a1)	Comprehensive Eye Examination. – For children who receive and fail to pass a vision screening as required under subsection (a) of this section, a comprehensive eye examination is required. If a public school teacher, administrator, or other appropriate school personnel has reason to believe that a child enrolled in kindergarten through third grade is having problems with vision, the school personnel may recommend to the child's parent that the child have a comprehensive eye examination.
The comprehensive eye examination shall be conducted by a duly licensed optometrist or ophthalmologist. The comprehensive eye examination conducted pursuant to this section shall consist of a complete and thorough examination of the eye and shall include the following:
(1)	Measurement of visual acuity.
(2)	Ocular alignment and motility.
(3)	Depth perception – stereopsis.
(4)	Fusion.
(5)	Slit lamp examination of the lid margins, conjunctivae, cornea, anterior chamber, iris, and crystalline lens.
(6)	Examination of the ocular adnexa, the anterior segment, and pupils.
(7)	Cycloplegic refraction and dilated fundus examination.
Health assessment vision screening under G.S. 130A‑440 is not a comprehensive eye examination for purposes of this section.
(b)	Repealed by Session Laws 2006‑240, s. 1(a), effective August 13, 2006.
(c)	[Summary By Provider. –] The results of a comprehensive eye examination conducted under this section shall contain a summary by the optometrist or ophthalmologist. Any treatment recommendations by the optometrist or ophthalmologist, such as spectacles for schoolwork, shall appear in the summary and school health card. The provider shall present a signed transmittal form to the parent upon completion of the examination. The parent shall submit the transmittal form to the school in accordance with this section.
(d)	Repealed by Session Laws 2006‑240, s. 1(a), effective August 13, 2006.
(e)	[Applicability of Other Provisions. –] G.S. 130A‑441, 130A‑442, and 130A‑443, pertaining to health assessments, apply to comprehensive eye examinations required under this section.
(f)	[No Exclusion For Failure to Comply. –] No child shall be excluded from attending school for a parent's failure to obtain a comprehensive eye examination required under this section. If a parent fails or refuses to obtain a comprehensive eye examination or to provide the certification of a comprehensive eye examination, the school shall send a written reminder to the parent of required eye examinations.
(g)	Repealed by Session Laws 2023‑46, s. 14, effective June 16, 2023.
(h)	["Parent" Defined. –] As used in this section, the term "parent" means the parent, guardian, or person standing in loco parentis.  (2005‑276, s. 10.59F(g); 2005‑345, s. 20(d); 2006‑240, s. 1(a); 2023‑46, s. 14.)

§ 130A‑441.  (Applicable to children enrolling in the public schools for the first time before the 2016‑2017 school year) Reporting.
(a)	Health assessment results shall be submitted to the school principal by the medical provider on health assessment transmittal forms developed by the Department and the Department of Public Instruction.
(b)	Each school having a kindergarten shall maintain on file the health assessment results. The files shall be open to inspection by the Department, the Department of Public Instruction, or their authorized representatives and persons inspecting the files shall maintain the confidentiality of the files. Upon transfer of a child to another kindergarten, a copy of the health assessment results shall be provided upon request and without charge to the new kindergarten.
(c)	Within 60 calendar days after the commencement of a new school year, the principal shall file a health assessment status report with the Department on forms developed by the Department and the Department of Public Instruction. The report shall document the number of children in compliance and not in compliance with G.S. 130A‑440(a).  (1985 (Reg. Sess., 1986), c. 1017, s. 1; 1989, c. 727, s. 156; 1993, c. 124, s. 2.)

§ 130A‑441.  (Applicable to children enrolling in the public schools for the first time beginning with the 2016‑2017 school year) Reporting.
(a)	Health assessment results shall be submitted on the statewide standardized health assessment transmittal form developed by the Department and the Department of Public Instruction and submitted to the school principal by either (i) the parent, guardian, or person standing in loco parentis for the student or (ii) the health care provider specified in G.S. 130A‑440(c), if authorized in writing by the parent, guardian, or person standing in loco parentis. The health assessment transmittal form shall include only the items listed below:
(1)	A statement that the form and information on the form will be maintained on file in the school once it has been completed.
(2)	The name of the school the student is attending or will attend.
(3)	A student information section to be completed by the parent, guardian, or person standing in loco parentis for the student that requires the following about the student: first, middle, and last name; date of birth; sex; race; ethnicity; county of residence; and home address.
(4)	A parent information section that includes the following: name of the parent, guardian, or person standing in loco parentis for the student; a telephone number; and space allowing the parent to share any concerns about the student's health with those individuals authorized to have access to the form in subsection (b) of this section.
(5)	A section that includes the following information, if applicable, supplied by a health care provider specified in G.S. 130A‑440(c):
a.	A list of medications prescribed for the student.
b.	A list of the student's allergies, the type of allergic reaction, and the response required.
c.	Guidance regarding a special diet for the student.
d.	Health‑related recommendations to enhance the student's school performance.
e.	Information on whether the student passed a vision screening and any concerns related to the student's vision.
f.	Information on whether the student passed a hearing screening and any concerns related to the student's hearing.
g.	An opportunity to indicate whether there are recommendations, concerns, or needs related to the student's health and whether school follow‑up is needed.
h.	An opportunity to provide comments.
(6)	Instructions to the health care provider specified in G.S. 130A‑440(c) to provide the student's current immunization record and any of the following applicable school health forms:
a.	School medication authorization form.
b.	Diabetes care plan.
c.	Asthma action plan.
d.	Health care plans for any other condition for which the school needs to be aware.
(7)	A certification from a health care provider specified in G.S. 130A‑440(c) stating: "I certify that I performed, on the student named above, a health assessment in accordance with G.S. 130A‑440(b) that included a medical history and physical examination with screening for vision and hearing and, if appropriate, testing for anemia and tuberculosis. I certify that the information on this form is accurate and complete to the best of my knowledge."
(8)	The date the health assessment was conducted.
(9)	The health care provider's name, signature, telephone and fax number, and the name and address for the health care provider's practice.
(10)	A section for the health care provider's stamp.
(b)	The form will be maintained on file in the school once it has been submitted. A student's official school record shall only reflect whether or not a health assessment transmittal form has been received. The health assessment transmittal form shall be open to inspection only by authorized North Carolina public school administrators, teachers, and other school personnel who require such access to perform their assigned duties. These personnel shall maintain the confidentiality of the form. Information contained on the health assessment transmittal form is confidential and is not a public record within the meaning of G.S. 132‑1. The local board of education shall provide, upon request, de‑identified health assessment information from the forms to authorized employees of the Department of Health and Human Services who require such information to perform their assigned duties.
(c)	Within 60 calendar days after the commencement of a new school year, the principal shall file a health assessment status report with the Department on a form developed by the Department and the Department of Public Instruction. The report shall document the number of newly enrolled children in compliance and not in compliance with G.S. 130A‑440(a). (1985 (Reg. Sess., 1986), c. 1017, s. 1; 1989, c. 727, s. 156; 1993, c. 124, s. 2; 2015‑222, s. 3.)

§ 130A‑442.  Religious exemption.
If the bona fide religious beliefs of the parent, guardian or person in loco parentis of a child are contrary to the health assessment requirements contained in this Article, this Article shall not apply to the child. Upon submission of a written statement of the bona fide religious beliefs and opposition to the health assessment requirements, the child may attend kindergarten without submitting a health assessment report. (1985 (Reg. Sess., 1986), c. 1017, s. 1; 1987, c. 114, s. 2.)

§ 130A‑443.  Rules.
Rules governing the contents for health assessment reports, the procedure for reporting under this Article, and those persons authorized to inspect the files shall be developed jointly by the Department of Public Instruction and the Commission for Public Health and shall be adopted by the Commission for Public Health. (1985 (Reg. Sess., 1986), c. 1017, s. 1; 2007‑182, s. 2.)