P.O. BOX 2120


May 17, 2002



Division Superintendents



Jo Lynne DeMary

Superintendent of Public Instruction



Inclusion of Iron Deficiency Screen and Urinalysis in School Entrance Physicals for Kindergarten or Elementary School Enrollment


This memo is to provide clarification received from the Virginia Department of Health for section 22.1-270 of the Code of Virginia. This section states as follows:

No pupil shall be admitted for the first time

to any public kindergarten or elementary school

in a school division unless such pupil shall

furnish, prior to admission, (i) a report from a qualified licensed physician, a licensed nurse practitioner, or a licensed physicians assistant acting under the supervision of a licensed physician, of a comprehensive physical examination of a scope prescribed by the State Health Commissioner performed within the twelve months prior to the date such pupil first enters such public kindergarten or elementary school


The State Health Commissioner has clarified through a memorandum to the Department of Education dated 12/21/01 that a comprehensive physical includes (a) a screen for iron-deficiency anemia, or (b) hemoglobin, or (c) a hematocrit and a urinalysis. The Virginia Department of Education and the Virginia Department of Health require documentation on the MCH 213D (Preschool Entrance Physical Examination and Immunization Form) of a hemoglobin or hematocrit within the previous 12 months, or documentation of an iron-deficiency anemia risk assessment as well as a urinalysis.


The Virginia Department of Health and the Department of Medical Assistance Services have adopted the iron deficiency screening found in the guidelines for health supervision of infants, children, and adolescents established and recommended by the U.S. Department of Health and Human Services, Health Resources and Services Administration Maternal and Child Health Bureau. These recommendations can be found in Bright Futures (2002)

These recommendations are also supported by the American Academy of Pediatrics, the American Medical Association, the American Public Health Association, the National Association of School Nurses, and the National Association of Pediatric Nurse Associates and Practitioners. Furthermore, the Centers for Disease Control and Prevention (CDC) recommend that health professionals assess children ages 1 to 5 years for risk of anemia.


Should you have any further questions, please contact Gwen P. Smith, RN, MSN school health specialist at 804-786-8671 or