District 27-B2 Vision Screening Mission: “To provide vision screening to the youth of our community for those who do not have access to pediatric eye screening programs. Our goal is to identify vision issues early enough in a child’s life to assist in correcting vision for life” In pursuit of our ongoing campaign against blindness, the Lions have adopted the use of Autorefractor cameras to help diagnose eye problems at a much younger age. The Autorefractor sometimes called a Photorefractor camera uses infrared imaging to diagnose many common eye conditions so our children can be treated for these conditions.
The following is a guide to various forms, documents, and presentations that can be used to assist you in providing vision screening services. To ensure that you are using the latest version of these files, please download them from this site before each usage or screening.
New updated forms are here. This page is a work in progress until all changes are made to update this page.
I HAVE FOUND OUT THAT SOME OF THE FORMS DO NOT OPEN IN THE BROWSER CHROME. IF YOU HAVE ANOTHER BROWSER ON YOUR COMPUTER USE THAT. THANKS!
LETTERS TO ZONE COORIDATORS AND CLUB VISION SCREENING
Lion Zone Cooridators and Club Vision Scrteeners letter sent out as of
NEW REDESIGNED BROCHURE FOR SCHOOLS AND PARENTS
WLF has redesigned their brochure for Schools and Parents. Please make this available to schools for use.
FORMS
OPT-OUT - OPTIONAL
Some Schools before school starts offier Opt-Out forms for varies activities. If your school does this you can supply them with this form. They keep track who will not be screened though the signed forms. Day Care or School Opt Out
PERMISSION FORM
If the School does not offer Opt-Out forms as an option you need to use a Vision Screening Permission Form - Download This is an editable file.
RESULT FORMS
Result forms go along with the parent or guardian. There are 2 different types of Results forms. This tells the parent or guardian how to proceed.
1. WLF Results form would be completed with each screening and given to parent or guardian.
There will be a Spanish Results Form Available soon.
2. 27-B2 Results Form is only given out to referrals along with the printout. Editable form.
REPORT FORMS
After you are done screening you need to send your reports in. There are 2 forms to choice from. Both are acceptable. Please follow the forms directions on what to do with them once they are complete.
Vision Screening Report Form - Short Updated 1/26 You will do the form either by class or grade.
To come with this these numbers click here for both examples. The first Page (Manawa Example) is by grade and very easy to do, even if you don't keep any files on the SPOT itself. The other option is age, which is the second sheet. You will need to export your file from the SPOT to a jump drive and then look at the jump drive for the files on page 2.
Anyone having questions on how-to regarding HIPPA Privacy, Screening and Shopko Opitcal there is a supplemeental document to the WLF Manual that is out there. Click here to see.
If your SPOT device is not available for use when you need check this report of SPOT devices available in district and find the closest one and see if you can borrow that one. The only issue with this is that will will not have your banner. Your banner is housed in the box in your Zone with the SPOT device. Please contact me and I can send you the file but you will need a jump drive to download it to. My Name and email is available at Region 5 Zone 2 information. If you don't know who to borrow the SPOT from the clubs are also listed on the report.
VOLUNTEERS
It is important that the screener knows what they can and cannot do. The Volunteer Code of Conduct is useful for this. Also, the Volunteer Confidentiality Agreement also explains what information needs to remain private.
Volunteer Code of Conduct Volunteer Confidentiality Agreement
OTHER FORMS
Club Banners
Algoma Allouez Antigo Ashwaubenon Bear Creek Bellevue Birnamwood Bonduel Brussels Caroline Casco Clintonville Coleman Pound Crandon Crivitz De Pere Denmark Door County Dyckesville Egg Harbor Embarrass River Forestville Maplewood Fox River Freedom Gillett Goodman Armstrong Creek Grand Chute Greenville Greenville Lioness Gresham Heart of the Valley Hortonville Howard-Suamico Hyland Lakes Iola Kaukauna Kewaunee Laona Lena Luxemburg Manawa Marinette Marion McCaslin Medina Dale Readfield Mountain Crooked Lake New London Niagara Oconto Oconto Falls Oconto Falls Lioness Pearson-Pickerel Peshtigo Pulaski Region 5 Z2 Seymour Shawano Lake Shiocton Sister Bay Sturgeon Bay Suring Tigerton Wabeno Washington Island Waupaca Wausaukee Weyauwega Fremont Wittenberg
