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The form specifies how to enter screening counts by preschool and school age, including totals for screened, rescreened, referred, and glasses referrals, then how to record follow-up outcomes for completed versus not completed medical referrals. It also details diagnosis categorization such as myopia, hyperopia, astigmatism, muscle balance, amblyopia, pathology, combinations, and normal results, plus reporting fields for special education referral criteria, color screening, and agency submission information. Reports are due by June 30.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/illinois-department-of-public-health-vision-conservation-annual-report-instructions-for-completing-form-idphv-3/537739/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/illinois-department-of-public-health-vision-conservation-annual-report-instructions-for-completing-form-idphv-3/537739.png","ImageObject",300,407,{"name":92,"@type":93},"PakDamar76","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-20","2026-10-10",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What screening totals must be entered on the form?","Question",{"text":112,"@type":113},"Enter the total number of children screened, rescreened, and referred. Also record the number with glasses and the number of glasses referrals. Sum columns 1 through 5 and enter the totals on line p.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How should follow-up results be reported?",{"text":117,"@type":113},"Report follow-up outcomes for preschool and school-age groups. Record the number of completed medical referrals (q) and the number of referrals not completed (r), then sum lines q and r to match the required totals.",{"name":119,"@type":110,"acceptedAnswer":120},"Which diagnosis categories are included in the report?",{"text":121,"@type":113},"The diagnosis section includes refractive errors (myopia, hyperopia, astigmatism, other), muscle balance, amblyopia, pathology, combinations of findings, and normal. Totals must be summed correctly across the listed categories and by age group.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},537739,1791696246,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39},962090893057,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","ILLINOIS DEPARTMENT OF PUBLIC HEALTH VISION CONSERVATION ANNUAL REPORT INSTRUCTIONS FOR COMPLETING FORM (IDPH/ V-3)  \nSCREENING  \nEnter all screening data by preschool, in line a, and by school age, in lines b-o. All full-time special education class children must be entered on line o.  \nColumn  \n1. NUMBER SCREENED. Enter the total number of children instrument screened. (Do not enter children wearing glasses in this column.)  \n2. NUMBER RESCREENED. Enter the total number of children rescreened.  \n3. NUMBER REFERRED. Enter the total number of children who met referral criteria following rescreening and/or were referred because of observable symptoms.  \n4. NUMBER WITH GLASSES. Enter the total number of children in the groups you screened who were wearing glasses.  \n5.  GLASSES REFERRAL. Enter the number of children wearing glasses who were referred.  \nSum data entered in each column, 1 through 5, and enter these sums on line p.  \nFOLLOW-UP RESULTS  \nEnter all follow-up results by school-age, in column 6, and preschool, in column 7.  \nNumber of Completed Medical Referrals (q) . Enter total number of children for whom a vision examination report has been returned or information obtained verifying examination and diagnosis. Do not include glasses referrals.  \nNumber of Referrals Not Completed (r) . Enter the total number of children for whom no report has been received or information obtained verifying an examination and diagnosis.  \nSum lines q, r and s, and columns 6, 7 and 8. The sums of column 8 and line s must be equal. The number entered in cell 8-s must equal the total number of children referred, cell 3-p.  \nDIAGNOSIS  \nEnter all diagnostic data by school age, in column 6, and preschool, in column 7.  \nTotal Number of Children Found To Have. Enter the total number of children with a diagnosis on the following lines:  \nA.  REFRACTIVE ERRORS  \n1. Myopia (t)  \n2. Hyperopia (u)  \n3. Astigmatism (v)  \n4. Other (w)  \nB.  MUSCLE BALANCE (x)  \nC. AMBLYOPIA  (y)  \nD.  PATHOLOGY (z)  \nE.  COMBINATIONS OF FINDINGS (aa)  \nF. NORMAL (bb)  \nSum lines t through cc and columns 6, 7 and 8. The sums of 8-q and 8-cc must be equal. The number entered in cell 8-cc must equal the number of completed referrals, cell 8-q.  \nNUMBER REFERRED TO SPECIAL EDUCATION (dd) . Enter the total number of children who met educational referral criteria.  \nCOLOR (ee) . Enter the total number of children screened for color and the total number who failed the screening.  \nPROGRAM  \nPrint or type agency name, i.e. school district name and number, health department name or other agency name. Print or type agency address: number and street, city, ZIP code and county. Enter the name and telephone number of the individual submitting the report. Enter the date the report is submitted.  \nSubmit one cumulative annual report from each school district, health department or other agency responsible for vision screening. Submit this report to the Department’s Vision and Hearing Program by June 30 of each year.  \nPLEASE TYPE OR PRINT LEGIBLY. CHECK ALL COMPUTATIONS. THIS FORM IS USED TO COMPILE STATEWIDE STATISTICS. THANK YOU FOR YOUR  \nCOOPERATION.  \nILLINOIS DEPARTMENT OF PUBLIC HEALTH  \nDIVISION OF HEALTH ASSESSMENT AND SCREENING  \nVISION CONSERVATION ANNUAL REPORT JULY 1,   TO JUNE 30,    \n\n|  | 1 Number Screened | 2 Number Rescreened | 3 Number Referred | 4 Number of Children with Glasses | 5 Glasses Referral | FOLLOW-UP RESULTS |  | 6 School\u003Cbr>-age |  |  | 7 Preschool |  | \u003Cbr>\u003Cbr>8 Total |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Preschool a |  |  |  |  |  | Number of completed referrals ........ .......q |  |  |  |  |  |  |  |\n| K b |  |  |  |  |  | Number of referrals not completed ……..r |  |  |  |  |  |  |  |\n| 1 c |  |  |  |  |  | Total   s |  |  |  |  |  |  |  |\n| 2 d |  |  |  |  |  | DIAGNOSIS |  |  |  |  |  |  |  |\n| 3 e |  |  |  |  |  | Total number of children found to have |  |  |  |  |  |  |  |\n| 4 f |  |  |  |","cbCairP6FpRNgK7K","https://ap.wps.com/l/cbCairP6FpRNgK7K","pdf",168534,"English","# Screening\n## Follow-up Results\n# Diagnosis\n## Program and Submission","[{\"question\":\"What screening totals must be entered on the form?\",\"answer\":\"Enter the total number of children screened, rescreened, and referred. Also record the number with glasses and the number of glasses referrals. Sum columns 1 through 5 and enter the totals on line p.\"},{\"question\":\"How should follow-up results be reported?\",\"answer\":\"Report follow-up outcomes for preschool and school-age groups. Record the number of completed medical referrals (q) and the number of referrals not completed (r), then sum lines q and r to match the required totals.\"},{\"question\":\"Which diagnosis categories are included in the report?\",\"answer\":\"The diagnosis section includes refractive errors (myopia, hyperopia, astigmatism, other), muscle balance, amblyopia, pathology, combinations of findings, and normal. Totals must be summed correctly across the listed categories and by age group.\"}]","ILLINOIS DEPARTMENT OF PUBLIC HEALTH VISION CONSERVATION ANNUAL REPORT - Instructions for Completing Form (IDPH/V-3) | PDF",1791605296]