1. (1) The DHHS will provide to the LEA the Vision Symptom Questionnaire for the classroom teacher to potentially identify a vision problem. The DHHS will update the questionnaire as needed.

2. (2) For a student who fails to achieve benchmark status on the benchmark reading assessment in grades 1-3:

   1. (a) the LEA shall notify the teacher within 30 calendar days of student performance on the benchmark reading assessment;
   2. (b) the teacher must complete the Vision Symptom Questionnaire within 45 calendar days of the administration of the assessment and submit the questionnaire to the school nurse;
   3. (c) the teacher need only complete the Vision Symptom Questionnaire once per school year; and
   4. (d) the school nurse shall use the Vision Symptom Questionnaire to evaluate the need for a tier 2 screening or refer to an eye care professional within 30 calendar days of receiving the Vision Symptom Questionnaire.

3. (3) For a student who is being referred or reevaluated for special education for a suspected disability affected by a vision difficulty:

   1. (a) the teacher must complete the Vision Symptom Questionnaire and submit to the school nurse; and
   2. (b) the school nurse shall use the Vision Symptom Questionnaire to evaluate the need for a tier 2 screening or refer to an eye care professional within 30 calendar days of receiving the Vision Symptom Questionnaire.

4. (4) For a student who is being referred by parent or guardian for vision concern:

   1. (a) the parent or guardian should complete the Vision Symptom Questionnaire and submit to the school nurse; and
   2. (b) the school nurse shall use the Vision Symptom Questionnaire to evaluate the need for a tier 2 screening or refer to an eye care professional within 30 calendar days of receiving the Vision Symptom Questionnaire.

KEY: eye exams, school vision, vision evaluations

Date of Last Change: November 5, 2023

Notice of Continuation: June 6, 2023

Authorizing, and Implemented or Interpreted Law: 53G-9-404