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COMMONWEALTH OF VIRGINIA SCHOOL ENTRANCE …

MCH 213 F revised 4/07 1 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 ) requires that your child is immunized and receives a comprehensive physical examination before entering public kindergarten or elementary SCHOOL . The parent or guardian completes this page (Part I) of the form. The Medical Provider completes Part II and Part III of the form.

MCH 213 F revised 4/07 2 COMMONWEALTH OF VIRGINIA SCHOOL ENTRANCE HEALTH FORM Part II - Certification of Immunization Section I To be completed by a physician, registered nurse, or health department official.

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