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Health Examination | Forms | Guidelines

The 2023 NYS Required Health Examination Form meets the requirements of the Sudden Cardiac Arrest (SCA) law. 
Schools are encouraged to share the 2023 updated Health Examination Form with parents/guardians and providers.

Schools may continue to accept the 2022 version, but must ensure that an assessment of increased risk of SCA
for students participating in athletics is completed. (Interval Health History Form)

All health examinations must be on the Required NYS Health Examination or EHR equivalent form. 

Health Examination Guidelines

Health Examination Guidelines for Schools (NYSED 2022)
Provides local educational agencies with information on obtaining student health examinations completed by a private healthcare provider (health certificates) along with a framework for establishing the mandated health appraisal program (health examination completed by the district medical director). It explains the purpose of the health examination requirements and provides guidance for developing effective procedures including planning, implementation of local policies, and follow-up.

FAQs - Health Examinations
FAQs are created utilizing information from NYSED guidelines. For detailed information, please review guidelines thoroughly.

Health Exam and Screening Requirements Charts | Determination for Ungraded Students

NYS & NYC Screening & Health Examination Requirements Chart (NYSCSH 7/18)

Chronological Age/Grade Chart (NYSCSH 4/24)

School Health Examination Form

Required NYS School Health Examination Form (PDF NYSED 2023) 
This form may be printed and completed by hand. 

Required NYS School Health Examination Form (Fillable PDF NYSED 2023)
This form may be completed electronically by saving it to your computer, entering the information into the fillable fields, and saving a copy for each student. 

Instructions for an EHR Compatible Form

Instructions for Completion of the New York State School Health Examination EHR Compatible Form (NYSED 2020) 
Provides information to healthcare providers indicating what must be included in an EHR form to meet the requirements. Although the EHR equivalent may not look like the required form, it must contain the same information as required in state laws, and the information is to be presented in relatively the same order.  

School Health Examination Form Sample Resources

Instructions for School Nurses and School Medical Directors Related to Completion of the Required Health Examination Form (NYSCSH 10/2023)
Contains instructions and customizable sample notifications for parents/guardians and community health care providers reminding them of the need to use the required form.

Certificate of Limitations Form

Sample Recommended Form - Medical Certificate of Limitations 
Used to document private provider recommendations for accommodation for PE. 

Sample Athlete with Disabilities Form
This resource from the American Academy of Pediatrics may be helpful in collecting additional health information from athletes with disabilities.

Dental Certificates

Dental Certificates 
Should be requested along with Health Examinations but are NOT required for school attendance. 

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Page Updated 1/30/26