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Resources for Screenings

Screening Protocol PDFs:

MD5M has established protocols that MUST be followed when doing Kidsight screenings. Please review the documents below to make sure you are operating in compliance with these protocols.

New?	Revised	Document
	2018-02	Screening Protocol
	2017-09	Data Entry and Security
	2020-10-01	COVID-19 Policies and Procedures
	2020-10-02	COVID-19 Liability Waiver Lion
	2020-10-02	COVID-19 Liability Waiver Location

English Language Forms

These PDF fillable forms have places where you need to fill in information (club name, screening date & location, etc) before printing the form. The places where you need to insert your information or select an option have shaded backgrounds. Erase any prompt text before typing your information on the form. The shading does not show when printed.

You can fill in the fields and make your selections when the document displays in your browser and print directly from your browser.

This is the most straight forward process.
You will always be using the current revision form!
The disadvantage is your entries are not saved.

You can Save/Download the form to your computer when it displays in your browser, open your local copy of the form in Adobe Acrobat Reader, make your inputs on the form, print the form, and save the PDF back to your computer.

You have the forms locally and do not need to go the the web when preparing for the next screening.
Occasionally check the web to make sure you are using the current revision form.
Make sure you update screening date & location for your next screening.

Or, fill in the fixed information before Saving/Downloading the PDF file locally (creating your club's template). Preparing for a screening, fill in the Date & Location before printing. Do not save the updated PDF over your club's template.

Your boilerplate/club specific information is on the form ready for the next screening.
Occasionally check the web to make sure you are using the current revision form.
Do not save the site specific entries over your PDF template that has your club's information filled in.

New?	Revised	Document
	2021-04	Letter to Pre-School
	2021-04	Cover Letter to Parents
	2021-04	Parent Consent Form
	2021-04	Results Letter to Parents: Not Referred
	2021-04	Results Letter to Parents: Referred
	2021-03-06	Could Not Screen Letter
	2021-02-10	PlusOptix Measurement Incomplete Letter
	2021-04	Photo Release Form - Minor
	2021-04	Photo Release Form - Adult
	2019-03	Vision Screening Information
	2021-06-02	Parent Consent Form Word Format
	2019-04	Results Letter to Parents: Not Referred Word Format
	2018-02	Results Letter to Parents: Referred Word Format

Chinese Language Forms

New?	Revised	Document
	2019-03	Cover Letter to Parents
	2021-02-01	Parent Consent Form
	2019-03	Results Letter to Parents: Not Referred
	2019-03	Results Letter to Parents: Referred
	2021-05	Photo Release Form - Adult

Hmong Language Forms

New?	Revised	Document
	2019-04	Cover Letter to Parents
	2019-04	Parent Consent Form
	2019-04	Results Letter to Parents: Not Referred
	2019-04	Results Letter to Parents: Referred

Somali Language Forms

New?	Revised	Document
	2019-03	Cover Letter to Parents
	2019-03	Parent Consent Form
	2019-03	Results Letter to Parents: Not Referred
	2019-03	Results Letter to Parents: Referred

Spanish Language Forms

New?	Revised	Document
	2021-03	Cover Letter to Parents
	2021-03	Parent Consent Form
	2021-03	Results Letter to Parents: Not Referred
	2021-03	Results Letter to Parents: Referred
	2021-03	Could Not Screen Letter

Follow Up Reports

These reports are required of all screenings, and are a requirement of our receiving the LCIF and MLVF grants used to purchase equipment. No individually identifiable data is required, but ages and number of children screened is needed, as is follow up status of all children referred for consultation with an eye care professional.

New?	Revised	Document
	2019-09	Screening Team Site Report
	2018-02	Screening Team Site Report Addendum (Report for children over 6 years old).
	2021-06-02	Indicator Site Report
	2018-04	Screening Follow Up Report

Camera Specific Instructions

These documents were created by Lion Lori Klein (5M2) for the Plus Optix Camera

New?	Revised	Document
	2017-08-21	How To Pre-Enter Data To The Plus Optix Camera
	2017-08-21	Sample Spreadsheet for Pre-Entering Data To Plus Optix Camera (.csv file)
	2017-08-21	How To Print Referral PDFs From The Plus Optix Camera
	2017-08-21	How To Delete Data From The Plus Optix Camera After Screening

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Or use "Right Click" on the link above, then choose "Save Link As" to save the file to a folder of your choice.