Health Examination FAQs
Charging for Health Examinations
May providers charge for copies of records if not done at the time of the physical? It is dependent upon the participation status of the provider with the insurer and whether their provider agreement addresses the issue. Complaints may be filed at New York State Department of Financial Services Consumer Assistance Unit One Commerce Plaza Albany, NY 12257 800-342-3736 (Consumers Hotline) 518-474-6600 (Outside of NYS) 518-474-2188 (Fax)
Confidentiality/Sharing Health Information
What laws cover the confidentiality of school health (education) records? School health records are considered educational records covered under the Family Educational Rights and Privacy Act (FERPA). Circulating protected health information lists, such as medical diagnoses of students to all personnel, is not an appropriate means of informing staff that there are students with special health care needs. The best practice is that the medical director or school nurse discuss pertinent student health needs with appropriate personnel and provide written emergency care plans. Information on FERPA is available on the Ed.gov website. Both school nurses and school medical directors should understand how FERPA applies to share confidential student information.
How may the school nurse inform appropriate school staff of individual student's health care needs? Health information should be shared with appropriate staff only on a need-to-know basis, as determined by the school administration in consultation with the school medical director to secure the child’s health and welfare. Need-to-know generally means that a staff member may need to provide care or intervention for a health condition affecting the student. Information stored in electronic records should have the appropriate safeguards in place to protect confidentiality.
What laws cover the confidentiality of private medical provider records? Private health providers follow the confidentiality requirements of the Health Insurance Portability and Accountability Act (HIPAA). As such, the private health provider may require written permission from the parent/guardian to share health information with the school. A joint HIPAA and FERPA document is available to clarify the laws and how they apply to schools.
When should dental certificates be requested? Schools must request dental certificates at the same time a mandated physical examination is required. Students entering the district who are required to have health certificates may submit a dental certificate if they choose. Students will be permitted to attend school regardless of whether or not they have a dental certificate. Schools are required to provide parents, upon request, with a list of free or reduced-cost local dentists, dental hygienists, and clinics that provide such service. A link to the list of dental providers is available under "D" for Dental Certificates. If the dental certificate is received, it should be filed in the cumulative health record. The recommended form can be found on the NYSED and NYSSHSC websites. The dental certificate may be signed by a dentist or dental hygienist.
Employment of Minors
What are the requirements for Employment Certificates? School districts in NYS are responsible for issuing employment certificates to qualified applicants (Education Law Article 65). School superintendents have the authority to designate principals or other school officials to act as certificating officials. Detailed information on the application process is available on the NYSED website. A Certificate of Physical Fitness must be presented to the certifying school official at the time of application. The school district must provide the exam if requested. The physical examination states that the student is healthy, and there are no known health problems at the time of application and that the applicant is physically qualified for lawful employment. If a known health problem exists at the time of the application, another physical examination may be required by the issuing authority (school), or the student may be issued a Limited Employment Certificate, which is valid for six months.
Entry, Grades, and Date of Exam
When are health examinations of public school students required by law? Education Law Article 19 and Regulations of the Commissioner of Education (8 NYCRR) require physical examinations of public school students:
- Entering the school district for the first time, and in grades pre-K or K, 1, 3, 5, 7, 9, and 11; and at any grade level by the school administration, in their discretion to promote the educational interests of the student
- In order to participate in strenuous physical activity, such as interscholastic athletics
- In order to obtain an employment certificate
- When conducting an individual evaluation or reevaluation of a student suspected of having a disability or a student with a disability
What elements are required for student health exams for mandated grades for entry, interscholastic sports, or CSE?
Education Law Article 19 and Regulations of the Commissioner of Education require physical examinations of public school students, to participate in strenuous physical activity, such as interscholastic athletics (8 NYCRR § 135.4(c)(7)(i)(e) and 136.3(a)(8)). The documentation of the exam must be completed on the form approved by the Commissioner of Education. Beginning, July 1st, 2021, physical examinations for school are to be documented on the NYS Required Health Examination Form or an electronic health record equivalent form. The health examination needs to include the following:
- A health history evaluation,
- Record of height & weight along with corresponding BMI and weight status category;
- Results of vision & hearing screenings;
- Results of scoliosis screening(s) if age/grade appropriate;
- Immunization record; and
- Medical and dental reports
- Physical examination, which includes a full-body screening conducted in both a seated and supine position
- Tanner developmental stage is only required for 7th and 8th graders who are seeking a waiver to be permitted to participate in high school level interscholastic athletics, or high school students seeking a waiver to participate in lower level interscholastic athletics.
- The use of telemedicine must include all of the information stated above, and the proper use of telemedicine equipment to assess a student must be used, use of only a video chat is not acceptable. The district’s medical director should be consulted before accepting any telemedicine health examinations, the district medical director has final approval of all health examinations.
What date can a school nurse accept as a valid health examination date on a health certificate from the private provider? A health examination performed by a private health care provider is referred to as a health certificate in law and regulation. A health examination performed by the school medical director is a health appraisal. Each certificate or appraisal is to describe the condition of the student when the examination was made, which is not more than twelve months prior to the start of the school year in which the examination is required, and shall state whether the student is in fit condition of health to permit his or her attendance in the public schools (Education Law Article 19 §903). The documentation of the exam must be completed on the form approved by the Commissioner of Education: Required NYS School Health Examination Form.
Is there a tool that can help me calculate this easily? Yes, The website: timeanddate.com can search for the days, months, and years between two different dates. This allows for the entrance of the health examination/certificate date and today's date to calculate the age of the document.
Does a student need a current physical in Pre-K and Kindergarten? If the student is enrolled in the district Pre-K and has a current NYS Required Health Examination Form, they do not need another for Kindergarten.
Health Examination Form
May a provider use an electronic signature to sign the health certificate? An increasing number of providers are using electronic records. Many also use electronic signatures, both of which may be accepted by a district if they choose to do so. Districts should inform parents/guardians of whether or not they will accept a private office or clinic form, an electronic form, or an electronic signature. Any time a school has a question regarding the authenticity of a health certificate, they should verify the validity of the submitted certificate with the provider.
Must schools use the NYS Required Health Examination Form to document the student's health exam?
Pursuant to Commissioner’s Regulations only the Required NYS School Health Examination Form or an electronic equivalent health record form can be accepted by schools for student physicals conducted on or after July 1, 2021. Some private healthcare exam forms did not contain the components required in state laws. Additionally, healthcare providers indicated it was difficult to complete the myriad of forms being required by individual school districts. Schools indicated it was time-consuming for staff to review the various forms provided to the school that was inconsistent in terms of content and meeting the requirements of law. With this regulation, there are now only 2 forms in the state for school exams. The NYC form is required for students attending NYC schools and the NYS form is required for students attending public schools outside of NYC.
May a school accept an electronic health exam form from a private healthcare provider?
Beginning July 1, 2021, physical examinations for school are to be documented on the NYS Required Health Examination Form or an electronic equivalent health record form.
Hearing, Vision and Scoliosis Screening
May the screening results reported on a health certificate be used and recorded as the mandated screening for the school year? If the physician, nurse practitioner or physician’s assistant notes the screening results in a manner that indicates an adequate screening has been completed, you may transcribe the results from the physical to the student’s cumulative health record. The student would not need to be screened again at school. The examiner would need to note the screening results such as: “20/20 R, 20/20 L” – or in a similar format rather than just writing “Pass”. Hearing screening should read: “Pass 20 dB at ___ frequencies for the screening to indicate that a sweep check was done at 20 decibels. If the examiner simply writes “Pass” you can’t be sure of what screening was done and the reported results should not be used for the school screening.
May the school medical director delegate vision, hearing, scoliosis, blood pressure, and any other locally determined screening which is part of the health appraisal? Yes, the school medical director may delegate them to school nursing personnel (Education Law, Article 19, § 905, (1).) Such delegation should be in a written policy. The results are recorded on the student’s CHR prior to the physical examination.
Out of State
May a public school nurse accept a physical signed by an out-of-state provider? ONLY If the provider practice is located within about 50 miles of an NYS border. This is allowable under Article 131, Medicine, section 6526- Exempt Persons: Any physician who is licensed in a bordering state and who resides near a border of this state, provided such practice is limited in this state to the vicinity of such border and provided such physician does not maintain an office or place to meet patients or receive calls within this state.
May a nonpublic school accept a health examination signed by a provider in another state? Nonpublic schools are not required to follow Article 19, therefore they decide if they will require a physical or not, and whether they will accept one for out-of-state. NYC, however, has additional laws. They must adhere to NYS professional practice laws on medication administration (NYS licensed prescriber only).
Performance of the Health Examination By School Medical Director
If a student does not submit a health certificate from their private medical provider, may the school medical director complete a physical examination without obtaining parental permission? Information in the Commissioner's Regulation 136.3 provides this framework for obtaining mandated physicals:
- Schools have 30 days from the date of school entry in Pre-K or K and in Grades 1, 3, 5, 7, 9, and 11, or upon initial entry to the school to obtains a copy of a health certificate from the parent/guardian of the student
- If after 30 days one is not provided, written notification is sent from school officials to the parent/guardian informing them that the school medical director will perform a health appraisal in 30 days if one is not provided by the parent/guardian to the school. Ideally, this should be sent by certified mail to ensure receipt.
- If a parent/guardian refuses to allow the student to be examined by the school medical director, the school administrator should consult with the school district's attorney before enforcing any existing board of education policies.
- Parental permission prior to the examination may be obtained but is not required.
When conducting the physical examination, should another adult be present? The best practice is that another adult, such as the school nurse is present.
Must the school medical director perform physical examinations (health appraisals) for foreign exchange students or other students who reside outside of NYS? Foreign exchange students are not permanent NYS residents (even when they reside at the school e.g. boarding schools), and therefore can be charged for the cost of health services.
Parental Consent for Health Services Treatment and Remedial Care (other than required health examinations and screenings)
What parental/guardian consent is required for health services, treatment, or remedial care of students (other than required health examinations and screenings)? In accordance with Education Law §910 and Public Health Law §2540, parental consent is required for health services, treatment, and remedial care (other than required health examinations and screenings). Districts may obtain passive parental consent for general health services such as nursing assessments, first aid, and emergency transport. Districts must have written consent for treatment and remedial care. This information is located on page 3 of the Health Examination Guideline.
Athletic Health Appraisal
What must an Athletic Health Appraisal Include? An athletic health appraisal must include, but is not limited to the:
- Student Health Examination Form - Completed by a private health care provider or school medical director. Required annually for the student wishing to participate in the school’s interscholastic athletic program.
- Pre-Participation/Interval Athletic Health History - Completed by parent/guardian no earlier than 30 days prior to the start of the sport. Required for the student wishing to participate in additional seasons of interscholastic athletics who has had a physical exam that school year.
- Medical Certificate of Limitations - Completed by the private health care provider. Provides information on the activity and level of activity in which the student may participate during physical education for students with medical limitations.
Who completes the health examination and approves participation in interscholastic athletics? It is at the discretion of the school medical director to accept a private provider’s physical or to perform the examination of the student. The district must provide the examination if requested by the parents/guardians. All students must have the approval of the school medical director prior to participating in interscholastic athletics. The school medical director has the responsibility to determine the physical capability of a student to participate in interscholastic athletics in consultation with the student’s primary medical provider and other specialists, the parents/guardians, the student, and the coaching staff.
What is the period of time for which a health exam is valid when used for athletic participation? The examination for interscholastic athletics is valid for qualifying a student's participation for a period of 12 continuous months- through the last day of the month in which the exam was conducted; and through the entire sports season, even if the exam’s expiration is before the season is complete.
What is the guidance regarding re-certification for athletic participation prior to each sports season? Prior to participation in each athletics sports season, all students should be given an interval athletic health history form which is located in Appendix B of the Guidelines to be completed and signed by the parent/guardian, unless a physical exam has been completed within the last 30 days. The school medical director or their designee (such designation should be in writing and the designee must be a licensed health professional whose scope of practice includes the assessment. LPN’s and athletic trainer’s scopes of practice do not include assessment.) should interview students with any interim health history which notes recent injury or illness.
Does an athlete need a health exam to participate in conditioning?
Conditioning off-season is not considered practice. It is not to be required that students attend the conditioning. See page 42 of the NYSPHSAA Handbook.
Is urinalysis required for a student's participation in interscholastic sports? Urinalysis was removed as an optional test. The only sport requiring specific urine testing is wrestling.
When must students be provided with adaptive/modified PE programs? Students in grades K-12 unable to participate in the regular physical education classes for a period longer than 2 weeks must be provided with an adaptive/modified PE program.
Review of the Health Certificate from the Private Provider
Who reviews the health certificate received from the private provider? The School Medical Director
May the Medical Director delegate review of the health certificate to the School Nurse (RN)? Yes. Information received from the student’s medical provider should be reviewed by the school medical director, or the school nurse (who is an RN- assessment is not in the scope of practice for LPNs) if designated in writing by the school medical director to do so. The school medical director should provide guidance for the management of abnormal findings.
Religious Exemption from Obtaining a Health Certificate or Appraisal
What is required for a parent or guardian to obtain a religious exemption for the health certificate/appraisal requirement? Health certificates/appraisals will not be required where a student, the parent, or person in parental relation to the student, objects to the examination on the grounds that the examination conflicts with their genuine and sincere religious beliefs. A written and signed statement from the student, parent, or person in parental relation to the student that they hold such beliefs must be submitted to the principal or the principal’s designee who may require supporting documents.
Transfer and Records Retention
What health records (immunization and health appraisal) should be included when a student transfers to another school? When a student transfers from one school to another, it is the responsibility of the school that is accepting the transferee to request from the school the student last attended, the student's cumulative immunization record, and the health care provider's immunization record for the student. The transferring school keeps a copy of these records and the receiving school gets the originals. If the school that the student last attended does not have a copy of the health care provider’s immunization record, then the accepting school should document this and make every effort to obtain that record. A record from the Immunization Registry (NYSIIS) is a valid original record. The most current health certificate/appraisal should also be sent. You can find additional information on records retention under "R" here.
How long should the interval athletic health history be kept? The interval athletic health history should be filed in the student's cumulative health record and removed when no longer valid after one year. If any new or significant health information is recorded on the interval health history, the health history form should be maintained in the CHR so that it remains a part of the student’s permanent health record.
Weight Status Category Documentation
Where can I find BMI/WSC information related to the health certificate/appraisal? Information can be found on the BMI/WSC web page link here.