VA MCH 213 G 2010-2025 free printable template

Form must be signed and dated by the Medical Provider or Health Department Official in the appropriate box. COMMONWEALTH OF VIRGINIA SCHOOL ENTRANCE HEALTH FORM Health Information Form/Comprehensive Physical Examination Report/Certification of Immunization Part I HEALTH INFORMATION FORM State law Ref. Code of Virginia 22. Any student entering school must submit this affidavit on a CERTIFICATE OF RELIGIOUS EXEMPTION Form CRE-1 which may be obtained at any local health department school...

How to fill out virginia school entrance form

How to fill out VA MCH 213 G

1. Obtain the VA MCH 213 G form from the official website or your VA representative.
2. Begin by filling out your personal information in the designated fields, including your full name, Social Security number, and contact details.
3. Provide details of your military service, such as branch of service, dates of active duty, and discharge status.
4. Indicate the specific medical condition or situation that necessitates support or assistance.
5. Include any relevant medical history or documentation that supports your request.
6. Review your completed form for accuracy and completeness.
7. Sign and date the form at the bottom.
8. Submit the form as instructed, either online, by mail, or in person.

Who needs VA MCH 213 G?

1. Veterans who seek assistance or benefits related to a specific medical condition.
2. Service members who have received care from the VA and need to document their health situation.
3. Individuals applying for support services or special programs offered by the VA.

• Who needs an MCH 213 G form?
• What is the purpose of the MCH 213 G form?
• What other documents must accompany the MCH 213 G form?
• When is the MCH 213 G form due?
• • What information should I provide in the MCH 213 G form?
  • What do I do with the form after its completion?

Who needs an MCH 213 G form?

This form is used in the educational institutions of Virginia. Before entering the public kindergarten and elementary school, the child must be examined by doctors. This form provides the result of this examination.

What is the purpose of the MCH 213 G form?

The school entrance form contains information about the child and his health condition. This information is very important ?in case of emergency situations, as it name the child’s allergies and chronic diseases.

What other documents must accompany the MCH 213 G form?

A copy of the signed immunization record should be attached to this form.

When is the MCH 213 G form due?

The Health form must be completed no longer than one year before the child starts the school.

What information should I provide in the MCH 213 G form?

The health statement has several parts for completion.

Part I is completed by the child’s parent or guardian. It contains the following information:

• Name of school

• Child’s name, date of birth, sex, language spoken,

• Address

• Name of mother or legal guardian

• Name of father or legal guardian

• Information about the child’s allergies, behavioral and other health problems, diabetes, head injury, hearing problems, spinal injury

• Any other important health-related information

• All the prescriptions the child takes regularly

• Information about the child’s doctors

The parent or guardian must sign and date the form as well.

Part II is the Certification of Immunization. This part is completed and signed by the medical provider and contains a record of the child’s vaccinations (name of the vaccines and dates administered).

Part III is the Comprehensive Physical Examination Report. It’s completed by the qualified physician or physician assistant. This part contains several screens for completing including health assessments, developmental screen, hearing screen, and vision screen.

The last two parts are certified by the Health Care Professionals.

What do I do with the form after its completion?

The completed health care form is submitted to the school administration.  

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What is VA MCH 213 G?

VA MCH 213 G is a form used to collect data related to maternal and child health services provided by the Veterans Affairs.

Who is required to file VA MCH 213 G?

Healthcare providers and organizations offering maternal and child health services to veterans are required to file VA MCH 213 G.

How to fill out VA MCH 213 G?

To fill out VA MCH 213 G, follow the instructions provided on the form, entering required information such as provider details, service dates, and patient demographics accurately.

What is the purpose of VA MCH 213 G?

The purpose of VA MCH 213 G is to gather relevant data to ensure proper tracking and provision of maternal and child health services to veterans.

What information must be reported on VA MCH 213 G?

Information required includes patient identification, service dates, types of services provided, and outcomes related to maternal and child health care.