INFORMATIONAL

The School Entrance Health Form: Health Information, 
Physical Examination and Immunization Certification (MCH-
213D) has been revised by the Virginia Department of Health. 
The revised form, entitled School Entrance Health Form 
(MCH-213D) is available from the Virginia Department of 
Education. This form can be ordered from the Virginia 
Department of Education by completing the Virginia 
Department of Education Requisition form (Attachment A). 
Please begin using the new form (MCH-213D) as soon as they 
are received.  At that time discard remaining copies of the 
previous form.

The form previously used will continue to be acceptable 
until July 1, 1999, for students entering school for the 
first time in the fall of 1999.

The Virginia Department of Health will provide the revised 
form (MCH-213D) and the information on immunizations to 
physicians.  The revised form will be distributed to local 
health departments, private physicians, private schools, and 
day care centers by the Virginia Department of Health.  

This form includes the new immunization requirement that 
students born on or after January 1, 1994, must have three 
doses of Hepatitis B Vaccine prior to entering school for 
the first time in September 1999 (Attachment B).

Beginning in September 1999, students may be enrolled 
conditionally if they have not completed the Hepatitis B 
series or any other required immunizations.  However, there 
must be documentation of at least one dose received and a 
schedule to receive the remaining dose(s) documented on the 

MCH-213D form signed by the physician or health department 
official.

These immunization requirements would not apply to children with 
a medical contraindication (documented on the form MCH-213D) to 
the Hepatitis B vaccine or when the parent has completed a 
Religious Exemption Form CRE-1 (Attachment C).  This 
documentation must be on file at the student's school.

Please be advised that the 1999 General Assembly passed the 
following legislation regarding immunizations to become effective 
July 1, 1999.

All children born on or after January 1, 1997, shall be 
required to receive immunization against varicella zoster 
(chicken pox) not earlier than the age of twelve months (365 
days).  Children who have evidence of immunity as 
demonstrated by laboratory confirmation of immunity or a 
reliable medical history of disease are exempt from such 
requirement.

Beginning July 1, 2001, all children who have not received 
three doses of hepatitis B vaccine will be required to 
receive such immunization prior to entering the sixth grade. 
(Code of Virginia Section 33.1-46).

Should you have any questions or comments, please contact Gwen 
Smith, R.N., Student Health Services Specialist at (804) 786-8671 
or gpsmith@pen.k12.va.us.

PDS/gs

Attachments:    A hard copy of this memo and its attachment
                will be sent to the superintendent's office.