SCREENING RESOURCES 

FOR 5' VIP & PASS2

Below are tools that you can download and reproduce to assist you with documentation and follow-up of the children that you have screened.


In addition to having the appropriate tools for documentation, you need to have a consistent system in place (for the whole school or the whole office) for ensuring that necessary information gets recorded. Make sure that all people involved understand the system, make sure that all involved know what type of information to give parents/caregivers when a child is referred and have a system in place for follow up when documentation is not received from the parent or eye care professional after a referral

Documentation and follow-up is a critical component of vision screening!

VIP Parent Brochures

The Parent Brochure should be used to let the parent/caregiver know the results of the vision screening.  Culturally appropriate parent education materials should be provided in the family’s native language. The Parent Brochure has been translated into languages that are common in Ohio

VIP Recording Form

The recording form can be used to help you track addresses and phone numbers for follow up, critical information about screening results and will help you to ensure that your referral rate stays within an acceptable range. You also need to have a consistent system in place for ensuring that necessary information gets recorded. Make sure that all people involved understand the system and have a system in place for follow up when documentation is not received from the parent or eye care professional after a referral.

VIP Cheat Sheets

The age-specific “Cheat Sheets” will walk you through all steps of a preschool vision screening and help you track any shapes that the child might miss during distance visual acuity screening.  In addition, it can act as documentation for each individual child’s vision screening and can be placed in their health/screening records.

Vision History Form

The Vision History Form has been developed for use in the pediatric office environment. It is based on the AAP Policy Statement for Eye Examination for Infants, Children and Young Adults by Pediatricians.

5' VIP & PASS2 RESOURCES

© 2016 by Prevent Blindness, Ohio Affiliate

This work is funded either in whole or in part by a grant awarded by the Ohio Department of Health, Bureau of Maternal, Child and Family Health, Save Our Sight and as a sub-award of a grant issued by The Ohio Department of Health under the Save Our Sight Program.