Georgia Department of Public Health
Form #4400
Certificate of Scoliosis Screening

What is scoliosis?

Scoliosis is an abnormal curvature of the spine. If detected early in a child’s life, it may be possible to treat the condition and prevent it from becoming more serious.

Who is required to file this Form #4400?

The parent or guardian of a student entering the 6th grade shall furnish to school authority a properly executed DPH Form #4400, Certificate of Scoliosis screening, as early as the first day of 5th and no later than 90 days after the student begins 6th grade. The parent or guardian of a student entering the 8th grade shall furnish to school authority a properly executed Form #4400, Certificate of Scoliosis screening, as early as the first day of 7th and no later than 90 days after the student begins 8th grade.

These time periods were chosen because these are the years when rapid growth occurs, and scoliosis is most likely to become observable.

What is the purpose of Form #4400?

Form #4400 is intended to ensure every child in Georgia public schools is screened for spinal deformities. The earlier these problems are detected the earlier parents/guardians can seek professional help for their student.

What screenings are required?

The “Adams Forward Bend Test” is required, and the results must be documented on the Form #4400 before it is filed with the school. The Adams Forward Bend test is a simple painless observation of the child’s back as he or she stands and bends over.

Who can conduct the screenings?

The test can be conducted by a physician with an active GA license or person working under the supervision of a physician with an active GA license, the local health department, and licensed school nurses.

What should a parent do if the “Needs further evaluation” box is checked?

If the “Needs further evaluation” box is checked, then the parent/guardian should take the student to a medical provider for a more detailed evaluation. Your physician or local health department may be able to help or recommend someone who can help.

What if a Form #4400 was previously filed for the child at another school?

Form #4400 should become part of the student’s permanent record. If a student transfers schools, the school where the form was filed is required to forward Form #4400 to the new school.

What happens if Form #4400 is not completed for students in 6th and 8th grades?

Students without Form #4400 on file will be screened by school staff during a mass scoliosis screening event during the school year.