Download sample forms, checklists, and other materials to facilitate your schoolwide screening program.
We are grateful to La Clínica de La Raza and Native American Health Center for providing these samples.
Recommendations
Age-based guidance for what to screen
Download PDFWorkplan
Sample workplan for implementing schoolwide screenings
Download PDFRoles & Responsibilities
List of staff roles and responsibilities
Download PDFVisit Form
For screening adolescent students
Download Word DocumentPoster
For outreach to students
Download PDFDental Assessment
For school-based oral health
Download Word DocumentLetter
For notifying parents of results
Download Word DocumentOpt Out
For parental denial of consent to treatment
Download Word DocumentClinic Flow
Step-by-step screening process
Download Word Document
This information is adapted from the Population-Wide Screenings in Schools Guide: A publication of UCSF and Family Health Together. We are grateful to our partners at ETR for funding and the UCSF School of Nursing for creating this content: Naomi Schapiro, RN, PhD, CPNP; Emily Green, RN, PhD; Victoria F. Keeton, PhD, RN, CPNP-PC; and Ivette Gutierrez, M.A.
We would also like to acknowledge Alameda County Center for Healthy Schools and Communities, Oakland Unified School District, La Clínica de la Raza, Native American Health Center, Lifelong Medical, Karen Gersten-Rothenberg, and Joanna Bauer for their contributions to this toolkit.