APPENDIX A. Forms for School Spinal Screening

APPENDIX A Forms for School Spinal Screening 23 SAN DIEGO ISD PRESS RELEASE A STATEWIDE SCREENING PROGRAM IS BEING OFFERED The Texas State Legisl...
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APPENDIX A

Forms for School Spinal Screening

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SAN DIEGO ISD PRESS RELEASE

A STATEWIDE SCREENING PROGRAM IS BEING OFFERED The Texas State Legislature passed a law in 1985 that requires all sixth and ninth grade students to be screened for spinal deformities. Early detection of abnormal spinal curvature can prevent serious health problems. This is a problem that may begin during the early adolescent years (from 10 – 14 years of age), with an estimated 1 in 10 adolescents having some degree of abnormal curvature. Curves that are detected early may only require periodic observation by a specialist. Moderate curves may require the wearing of a brace, which is usually supervised by an orthopedic specialist. In most cases, need for major surgery for this deformity can be eliminated through early detection. Spinal screening for (School and/or School District, City and/or County) ,

school children has been scheduled to begin on (Day of Week)

. (Date)

Children will be screened for two types of spinal deformities: scoliosis and kyphosis. Scoliosis is a condition in which the spine is twisted, causing misalignment of the upper body or lower back. This condition can worsen and lead to much pain, as well as complications of the heart and lungs. Kyphosis is an exaggerated rounding of the spine. Progression of these two conditions can often be arrested if detected early. For more information regarding the scheduled spinal screening, contact: . (Name, Title, Phone) For more information regarding state-mandated spinal screening in Texas schools, contact the Texas Department of State Health Services at 1-800-252-8023. .

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SAN DIEGO ISD PRE-SCREENING LETTER TO PARENTS

Dear Parent/Guardian: School will be conducting spinal screening on . The purpose of spinal screening is to detect the signs of abnormal curves of the spine at their earliest stages so that the need for treatment can be determined. Scoliosis, a common spinal abnormality found in adolescents, is a sideways twisting of the spine. It is usually detected in children between 10 and 14 years of age. Kyphosis, sometimes called round back, is an exaggerated rounding of the upper back and is often confused with poor posture. Many cases of curvature of the spine are mild and require only ongoing observation by a physician when they are first diagnosed. Others can worsen with time as the child grows and require active treatment such as bracing and surgery. Early treatment can prevent the development of a severe deformity, which can affect a person’s appearance and health. The procedure for screening is simple. Screeners who have been specially trained will look at your child’s back while he/she stands and then bends forward. For this examination, boys and girls will be seen separately and individually. STUDENTS SHOULD WEAR OR BRING SHORTS TO SCHOOL FOR THE EXAM. ALL STUDENTS MUST REMOVE THEIR SHIRT FOR THIS EXAM. FOR THIS REASON, WE REQUEST THAT GIRLS WEAR A HALTER TOP, TUBE TOP, SPORTS BRA, OR A TWO-PIECE SWIMSUIT TOP UNDERNEATH THEIR SHIRT ON EXAM DAY. Parents will be notified of the results of the screening only if professional follow-up is necessary. This screening procedure does not replace your child’s need for regular health care and checkups. According to state law, all students in grades 6 and 9 (or grades 5 and 8) must receive the spinal screening. If, for religious reasons, you do not wish to have your child screened, you are to submit an affidavit of religious exemption to this office no later than . Thank you for your cooperation,

Sincerely,

(School Administrator)

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CARTAA LOS PADRES ANTES DEL EXAMEN

Estimados padres o tutores: La escuela llevará a cabo exámenes de la columna vertebral el . El propósito de los exámenes de la columna vertebral es detectar los signos de curvaturas anormales de la columna vertebral en sus primeras etapas para determinar si es necesario el tratamiento. La escoliosis, anormalidad común de la columna vertebral que se observa en adolescentes, es una curvatura de la columna vertebral hacia los lados. Es usualmente detectado en niños de 10 a 14 años de edad. La cifosis, algunas veces llamada espalda encorvada, es una curvatura exagerada de la parte superior de la espalda y es muchas veces confundida con una mala postura. Muchos de los casos de curvaturas en la columna vertebral son leves y requieren únicamente de observación continua de un médico después del primer diagnóstico. Otras pueden empeorar con el tiempo a medida que el niño crece y éstas requieren de un tratamiento activo como aparatos ortopédicos y cirugía. El tratamiento temprano puede prevenir el desarrollo de una deformidad severa, la cual puede afectar la apariencia y salud de la persona. El procedimiento del examen es simple. Las personas que examinan y quienes han sido entrenados en la especialidad, observarán la espalda de su niño mientras que él o ella permanece de pié y después se dobla agachándose hacia adelante. Para llevar a cabo este examen, los niños y niñas serán observados por separado e individualmente. PARA LLEVAR A CABO EL EXAMEN, LOS ESTUDIANTES DEBERÁN VESTIRSE CON PANTALONES CORTOS O TRAERLOS A LA ESCUELA. TODOS LOS ESTUDIANTES DEBEN QUITARSE SU CAMISA DURANTE EL EXAMEN. POR ESTA RAZÓN LES PEDIMOS QUE EL DÍA DEL EXAMEN, LAS NIÑAS SE VISTAN CON BLUSAS QUE SE AMARRAN EN EL CUELLO, BLUSAS SIN TIRANTES, BRASIER PARA DEPORTES O, CON LA PARTE SUPERIOR DE UN TRAJE DE BAÑO DE DOS PIEZAS, ABAJO DE UNA BLUSA. A los padres se les notificará sobre los resultados del examen, únicamente si se necesita un seguimiento profesional. Este examen no reemplaza la necesidad de atención de salud y de los exámenes que se hacen con regularidad en su niño. De acuerdo con la ley estatal, todos los estudiantes de grados 6 y 9 (o grados 5 y 8) deben recibir el examen de la columna vertebral. Si es que, por razones religiosas, usted no desea que a su niño se le haga el examen, deberá entregar a esta oficina una declaración jurada de exoneración religiosa, no después del . Agradecemos su cooperación.

Atentamente,

(Administrador escolar) 28

WATCH OUT FOR SCOLIOSIS Scoliosis, an abnormal curve of the spine, can be corrected if detected early...

What is scoliosis? Scoliosis is a “side to side” curve of the back. It is a deformity of the spinal column or backbone. What causes scoliosis? Most scoliosis is of unknown cause (“idiopathic”). Recent studies suggest that heredity does play a part in these cases. Therefore, if a person is found to have scoliosis, other family members should also be checked. Who is affected by scoliosis? Anyone can be affected by scoliosis. Onset usually occurs between the ages of 10 and 13, when the child begins the rapid growth spurt. Scoliosis can affect members of both sexes, but occurs more frequently in females, who account for approximately 85% of the cases. Why is screening for scoliosis important? It is most important to detect the condition as early as possible so that treatment can be provided. Without treatment, undetected scoliosis can get worse rapidly during the growth years and result in physical deformity, limitation of physical activity and other more serious complications. What are the signs of scoliosis? Frequent signs are a bump over the shoulder blade; one shoulder or hip higher than the other; unequal distance between the arms and body, and clothes that “don’t hang right.” These signs are not always noticed and can be easily mistaken for poor posture. What is the treatment for scoliosis? In many instances of mild curvature, periodic supervision by a doctor is all that is necessary. When

medical treatment becomes necessary, an orthopedic surgeon (bone specialist) may recommend a brace or surgery depending on the condition. Regular follow-up while the child is wearing the brace is important. The doctor may prescribe a daily exercise and fitness program to maintain the muscles in good shape and promote a sense of well being, but exercise alone will not correct the problem. When other methods have failed or the scoliosis is severe, surgery may be necessary. After the operation, the child will need to wear a cast or brace for a number of months and continue to be supervised by an orthopedic surgeon. The remaining disability may be minimal and the patient may lead a normal life after recovery. Are schools required to provide screening? House Bill 832 passed by the Texas Legislature in 1985 requires screening for abnormal spinal curves in grades 6 and 9 (schools may adopt programs to screen grades 5 and 8 instead of 6 and 9). If a child shows any signs of a possible deformity, the school is required to notify the parents. What can parents do? If notified that their child may have an abnormal spinal curve, parents should take their child to the doctor for a diagnosis. Parents can also learn to check their child for a curve of the spine. If they suspect that their child may have a problem, they may check with the school nurse, the health department, or their private doctor.

Revised February, 2003

Here is a simple way to check your child for scoliosis* NORMAL

POSSIBLE SCOLIOSIS

• head centered over mid-buttocks

• head tilted to one side of mid-buttocks

• shoulders level

• one shoulder higher

• shoulder blades level with no bumps or buldges

• one shoulder blade higher with a possible bump or bulge

• hips level and equal on both sides

• one hip sticks out more than the other

• equal distance between arms and body

• unequal distance between arms and body

• straight backbone

• curved backbone

NORMAL

POSSIBLE SCOLIOSIS

• both sides of upper and lower back are equal

• one side of rib cage and/or the lower back bulges out

• hips level and equal on both sides

NORMAL

POSSIBLE SCOLIOSIS

• even and equal on both sides of the upper and lower back

• bump or bulge on the upper or lower back, or both

Also Screen for Kyphosis...

POSSIBLE KYPHOSIS (“round back”)

NORMAL • smooth round even arc of the back

• lack of smooth arc • exaggerated roundness of back

*Courtesy of the National Scoliosis Foundation, Inc. www.scoliosis.org Revised 2/2003

VIGILANDO QUE NO SE DESARROLLE LA ESCOLIOSIS La Escoliosis, una curvatura anormal de la columna, puede ser corregida si se detecta a tiempo ¿Qué es la escoliosis? La escoliosis es una curvatura de “lado a lado” de la espalda. Es una deformidad de la columna vertebral o espina dorsal.

Cuando el tratamiento médico se hace necesario, un cirujano ortopédico (especialista en huesos) podría recomendar aparatos ortopédicos o cirugía, dependiendo de la condición.

¿Qué causa la escoliosis? La mayor parte de la escoliosis resulta por causas desconocidas (“idiopáticas”.) Estudios recientes sugieren que el factor hereditario tiene algo que ver en estos casos. Por lo tanto, si se descubre que una persona tiene escoliosis, otros miembros de la familia también deberán ser examinados.

Mientras el niño esté usando el aparato ortopédico, es importante que con regularidad se continúe con el tratamiento. El doctor también podría recomendar un programa diario de ejercicios y actividades para mantener los músculos en buena forma física y contribuir a una sensación de bienestar, pero el ejercicio únicamente no va a corregir el problema.

¿A quién afecta la escoliosis? Cualquier persona puede resultar afectada por la escoliosis. El principio generalmente ocurre entre los 10 y los 13 años de edad, cuando el niño empieza la etapa de crecimiento más rápida. La escoliosis puede afectar a miembros de la familia de ambos sexos, pero ocurre con más frecuencia en las mujeres, quienes forman parte aproximadamente de un 85% de los casos.

Cuando otros métodos han fallado o, la escoliosis es severa, la cirugía podría ser necesaria. Después de la operación, el niño necesitará traer un yeso o aparato ortopédico por cierto número de meses y continuar bajo la supervisión del cirujano ortopédico. La incapacidad que finalmente quede podría ser mínima y el paciente podrá llevar una vida normal después de recuperarse.

¿Porqué es importante hacer un examen de escoliosis? Es de suma importancia detectar esta condición tan pronto como sea posible, para poder proporcionar tratamiento. Sin tratamiento, la escoliosis puede empeorar rápidamente durante los años de crecimiento y finalmente resultar en deformidad física, en limitación de las actividades físicas y otras complicaciones más serias. ¿Cuáles son los signos de la escoliosis? Los signos frecuentes son: protuberancia en el omóplato; un hombro o cadera más alta que la otra; distancia desigual entre los brazos y el cuerpo o, la ropa que “no queda bien.” Estos signos no siempre son notados y pueden ser considerados fácilmente como una mala postura. ¿Cuál es el tratamiento de la escoliosis? En muchos casos en que la curvatura es moderada, la supervisión periódica de parte del médico es lo único que se necesita.

¿Están las escuelas obligadas a proporcionar un examen físico? La Legislatura en Texas pasó el House Bill 832 [ley No. 832] en 1985, el cual exige que se examine a los estudiantes de los años escolares del 6 a 9 para ver si tienen curvaturas en la espina dorsal (las escuelas pueden adoptar programas para examinar a los estudiantes de los años escolares del 5 y 8 grado en vez del 6 y 9.) Si un niño muestra cualquier signo de una posible deformidad, a la escuela se le requiere notificar a los padres. ¿Qué pueden hacer los padres? Si a los padres se les ha notificado que su niño podría tener una curvatura anormal en la columna, los padres deben llevar a su niño al doctor para obtener un diagnóstico. Los padres también pueden aprender a revisar a sus niños y ver que no desarrollen una curvatura en la espina dorsal. Si ellos sospechan que su niño pueda tener un problema, pueden hablar con la enfermera de la escuela, con el departamento de salud o con su médico privado.

Esta es una manera simpe de revisar a su nino para ver si no tiene escoliosis NORMAL

POSIBLE ESCOLIOSIS

• La cabeza alineada arriba a la mitad de las nalgas

• La cabeza inclinada hacia un lado de la mitad de las nalgas

• El nivel de los hombros

• Un hombro más arriba que el otro

• El nivel de los omóplatos sin protuberancias o abultamientos

• Un omóplato más alto con una posible protuberancia o abultamiento

• El nivel de las caderas, igual en los dos lados

• Una cadera más salida que la otra

• Distancia igual entre los brazos y el cuerpo

• Distancia desigual entre los brazos y el cuerpo

• Columna vertebral derecha

• Curvatura de la espina dorsal

NORMAL

POSIBLE ESCOLIOSIS

• Los dos lados de arriba y abajo de la espalda son iguales

• Un lado de las costillas y, o la parte baja de la espalda sobresale

• El nivel de las caderas es igual en los dos lados

NORMAL

POSIBLE ESCOLIOSIS

• Los dos lados de la parte de arriba y abajo de la espalda nivelados e iguales

• Protuberancia o abultamiento en la parte de arriba o abajo de la espalda o, en ambas partes

Revise también que no halla una Cifosis POSIBLE CIFOSIS (“espalda redonda”)

NORMAL • Arco suave, redondo y parejo de la espalda

• Falta de arco suave • Redondez exagerada de la espalda

*Cortesía de la National Scoliosis Foundation, Inc. www.scoliosis.org

Revised 2/2003

AFFIDAVIT OF RELIGIOUS EXEMPTION STATE OF TEXAS COUNTY OF

BEFORE me, the undersigned authority, on this day personally appeared , who, after being duly sworn, deposes and says: (Parent or Guardian) “I understand that Texas law requires all public and private schools to screen children in grades 6 and 9 for abnormal spinal curvature before the end of the school year, and that schools may also choose to conduct their spinal screening programs in grades 5 and 8. I hereby request that

, NOT undergo (Name of Student)

spinal screening because it conflicts with tenets and practices related to our religious affiliation.

(Parent or Guardian)

Sworn and subscribed before me by the said the

day of

on this ,

.

(Notary Public in and for the State of Texas)

DECLARACIÓN JURADA DE EXONERACIÓN RELIGIOSA

ESTADO DE TEXAS MUNICIPIO DE

ANTE mí, la autoridad abajo firmante, en este día compareció en persona , quien, después de haber sido debidamente jurado, declara y dice: (Padre o tutor)

“Entiendo y acepto que la ley de Texas exige a todas las escuelas públicas y privadas que examinen a los niños de los años escolares 6 y 9 para detectar curvaturas anormales de la espina dorsal, antes de finalizar el año escolar y, que las escuelas también podrían, en los años escolares 5 y 8, llevar a cabo su programa de examen de la espina dorsal. Por medio de la presente yo pido que a

, NO se le (Nombre del estudiante)

someta al examen de la espina dorsal porque crea conflicto con los principios y prácticas relacionadas a nuestra afiliación religiosa.

(Padre o tutor)

Bajo juramento y suscrito ante mí por días del mes de

(Notario Público en el estado y, para el estado de Texas)

a los de

.

G - Lumbar hump

Date of Screening: Grade: Student Name

4

2

M/F

1

2

3

6

4

5

6

Y/N Y/N

Y(Date)/N

Additional Follow-Up Required

5

Diagnosis & Treatment Report Received

G - Lumbar hump

Referred for Examination

Screener(s):

3

Family Contacted

1

Scoliometer Readings (Optional)

S - Sway back E - Waist F - Hips

Rescreen Confirmed Findings

R - Round back

Rescreened

C - Spine D - Scapula

Currently Under Treatment

School/District:

A - Head B - Shoulder

Abnormality Detected

School Spinal Screening Worksheet

Y/N

/

Y(Date)/N

Y/N

Y(Date)/N

Y/N

FILLING OUT THE SCHOOL SPINAL SCREENING WORKSHEET: This form is to assist with re-screening and follow-up by providing a place to indicate and reference your initial findings. This form allows you to note the student’s position in which a possible abnormality was found, and section(s) of the body indicating that abnormality. Each of the screening positions has a corresponding numbered column. Sections of the body and some of the conditions you may find have corresponding letters. In the appropriate column, place letters to indicate the sections of the body showing a possible abnormality. For example, if one shoulder appears higher than the other when viewing a student in position 1, place a “B” in column 1 under that student’s name.

SPINAL SCREENING PROGRAM PARENT NOTIFICATION AND REFERRAL STUDENT: ____________________________________________ BIRTHDATE: _______________ ADDRESS: _______________________________________________________________________ SCHOOL: _______________________________

SCHOOL TELEPHONE: ___________________

Dear Parent/Guardian: Students in our schools were recently screened for a curve of the spine that can appear during the years of rapid growth between ages 10 and 16 years. Your child has signs of a possible curve listed below. Two kinds of curves are scoliosis (sideways curve) and kyphosis (round back). It is your responsibility to take this form to a doctor of your choice who can do a complete check of the spine. After the doctor has examined your child and completed this form, please return it to school. If you cannot afford a doctor or have questions, contact the school for information. Thank you for your cooperation: Signature of School Administrator or Nurse

Date

SCHOOL SCREENING FINDINGS: L

R

L High shoulder Shoulder blade stands out more than the other Obvious curve of the spine in area of rib cage Round back

R Rib hump Obvious curve of spine in lower back Hip higher than the other side

Other: School Screener’s Name & Title:

Date:

PROFESSIONAL EXAMINATION REPORT: Diagnosis: Recommendations: No Treatment

Treatment:

Observation Brace Surgery Other (please describe): _____________________________ Referral (please describe): ___________________________

Activity Limitation (if any, please describe): Additional Comments: ________________________________________________________________ Return Appointment: No Yes - Return Date: ________________________________________________________________ Doctor’s signature or hand stamp

_______________ Date

Doctor’s Mailing Address/Phone: ___________________________________________________________________

For school use: This form completed and received by school (name/date): This form not returned to school (reason):

PROGRAMA PARA EXAMEN DE LA COLUMNA VERTEBRAL NOTIFICACIÓN A LOS PADRES Y RECOMENDACIÓN CON ESPECIALISTA ESTUDIANTE:

FECHA DE NACIMIENTO:

DIRECCIÓN: _________________________________________________________________________________ ESCUELA:

TELÉFONO DE LA ESCUELA:

Estimado padre o tutor: Los estudiantes de nuestras escuelas fueron recientemente examinados para ver si tenían curvaturas de la espina dorsal, que se presentan durante los años de crecimiento acelerado en las edades de 10 y 16 años. Su niño muestra signos de posible curvatura y se describen a continuación. Hay dos tipos de curvaturas, la escoliosis (la curvatura hacia los lados) y la cifosis (la espalda encorvada). Es responsabilidad suya llevar esta información al doctor que usted escoja y quien podrá hacer una evaluación completa de la espina dorsal. Después que el doctor examine a su niño y llene esta forma, sírvase devolverla a la escuela. Si usted no puede pagar la consulta con el doctor o tiene preguntas, póngase en contacto con la escuela para obtener más información. Gracias por su cooperación: Firma del administrador escolar o enfermera

Fecha

RESULTADOS DEL EXAMEN Izq. Der. Der. [] [ ] Protuberancia en las costillas (rib hump) [ ] Hombro alto (high shoulder) [] [ ] Curvatura obvia de la espina en la parte baja [ ] Omóplato que sobresale más que el otro de la espalda (obvious curve of spine in lower (shoulder blade stands out) back) [ ] [ ] Curvatura obvia de la espina en el área de la caja torácica (obvious curve of spine in [] [ ] Una cadera más alta que la otra (one hip rib cage area) higher) [ ] Espalda encorvada (round back) Otro:________________________________________________________________________________________ Nombre y cargo de la persona que examinó en la escuela: Fecha: Izq. [] []

PROFESSIONAL EXAMINATION REPORT: Recommendations: No Treatment

Diagnosis: ____________________________

Treatment:

Observation Brace Surgery Other (please describe): _____________________________ Referral (please describe): ___________________________ Activity Limitation (if any, please describe): ________________________________________________ Additional Comments: ________________________________________________________________ Return Appointment: No Yes - Return Date: _________________ _________________________________________________________________ ______________ Doctor’s signature or hand stamp

Date

Doctor’s Mailing Address/Phone:

For school use: This form completed and received by school (name/date): This form not returned to school (reason): __________________________________________________

MAIL TO: Department of State Health Services Health Screening Branch Spinal Screening Program 1100 West 49th Street Austin, TX 78756-3199

SEE OTHER SIDE FOR INSTRUCTIONS & LATE EXAM RESULTS

SPINAL SCREENING REPORT (form M-51) NUMBER

(10 DIGIT PEIMS/TEA ID NUMBER)

NAME

OF

SCHOOL

DISTRICT

CITY

OR

SCHOOL

COUNTY

CONTACT (name/title/phone)

RESULTS OF REFERRALS ONLY

Scoliosis

Kyphosis

Other

E

F

G

H

J

K

Results Unavailable

Normal

D

Other

Referred

C

Operation Surgery

Rescreened

B

TREATMENT PLAN Observation Only

Screened

(Do not screen)

Under Prior Treatment

Grade

PHYSICIAN DIAGNOSIS

Orthosis Bracing

STUDENT SPINAL SCREENING

5F 5M 6F 6M 7F 7M 8F 8M 9F 9M 10F 10M 11F 11M 12F 12M Totals

A

Chief Administrator’s Signature

Title

I

L

Date

SUBMIT COMPLETED FORM TO TDH BY JUNE 30, For questions about completing this form contact the DSHS Spinal Screening Program at 1-800-252-8023

M

INSTRUCTIONS FOR THE SPINAL SCREENING REPORT (FORM M-51)

LATE EXAM RESULTS

School districts, private school systems, and charter schools: use this form to report cumulative totals of the spinal screenings conducted at each of your campuses. Individual public/private school campuses within a district/system: this form is useful for reporting campus totals to main office. The main office puts results of all campuses onto one form and submits that form to TDH.

Use this table to record the results of referrals (if any) that were made the last school year, but returned too late to be included on last year’s spinal screening report form.

Observation

Bracing

Surgery

Other

CHIEF ADMINISTRATOR’S SIGNATURE: Completed form should be signed by a chief district/ school administrator before being submitted to the Department of State Health Services.

Other

DOUBLE CHECK YOUR MATH: Sum of Columns E, F, G, H, & M should equal sum of Column D. Make sure you did not enter diagnosis/treatment for students under prior treatment (Column B).

Kyphosis

TREATMENT PLAN (Columns I - M) Mark only one treatment for each student. If a student receives mutiple treatments, mark only the treatment that appears furthest to right on this form’s treatment columns. (I) Observation only: Enter number of students to be observed only at this time. (J) Bracing: Enter number of students for whom a brace has been prescribed. (K) Surgery: Enter number of students for whom surgery has been indicated (L) Other: Enter number of students receiving a treatment not indicated above. (M) Results unavailable: Enter number of referred students for whom professional exam results are unavailable. Results should be submitted next year on the LATE EXAM RESULTS table.

Scoliosis

PHYSICIAN DIAGNOSIS (Columns E - H) (E) Normal: Number of students determined by their physician to have normal curvature. (F) Scoliosis: Number of students that received a diagnosis of scoliosis from their physician. (G) Kyphosis: Number of students that received a diagnosis of kyphosis from their physician. (H) Other: Number of students that received a diagnosis for a condition not listed above.

Normal

RESULTS OF REFERRALS ONLY (COLUMNS E - M) This section is for recording the results of the professional exams of those students referred. Do not enter your assessment of the condition. If results are not available, indicate that in Column M.

Grade

STUDENT SPINAL SCREENING (COLUMNS A - D) Grade: Enter numbers under the respective students’ grade (5-12) and sex (F or M ). (A) Under prior treatment: Enter number of students who have already received professional treatment for a spinal abnormality. Do not screen these students and do not enter their diagnosis or treatment on the report form. (B) Students screened: Enter number of students screened. (C) Rescreened: Enter number of students that received a second screening as result of a possibly abnormal finding during the initial screening. (D) Referred: Enter number of rescreened students above whose parents were given a spinal screening parent notification and referral for a professional examination.

TREATMENT

DIAGNOSIS

E

F

G

H

I

J

K

L

5F 5M 6F 6M 7F 7M 8F 8M 9F 9M 10F 10M 11F 11M 12F 12M Totals