Q: What regulation mandates a required NYS School Health Examination Form?  
A: Commissioner's Regulations CR 136.3 - School Health Services to be Provided 
(c) Health certificates and proof of immunization
    1. Health Certificates
      (i) The health certificate shall:
          (a) be on a form prescribed by the commissioner and signed by a duly licensed physician, physician assistant, or nurse practitioner

Q: Why is a specific NYS school health exam form required for school physical exams?
A: Pursuant to Commissioner's Regulations, only the Required NYS School Health Examination Form or an electronic health record equivalent form can be accepted by schools for student physicals conducted on or after July 1st, 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 required forms by individual school districts. Schools indicated it was time-consuming for staff to review the various forms provided to the school that were inconsistent in content and meeting the requirements of law. There are now only two forms in the state for school exams with this regulation: The NYC form required for students attending NYC schools and the NYS form required for students attending public schools outside of NYC.

Q: May a school (outside of NYC) accept the NYC Health Examination Form?
A: Yes, The NYC form should be reviewed as an Electronic Health Record (EHR) equivalent form. Although an 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. 

Q: Are nonpublic/private schools required to use a specific form?
A: No, Nonpublic/private schools outside of NYC are not required to use a specific form or require a health examination.

Q: May students be excluded from school for not providing the Required NYS School Health Examination Form?
A: No, Parents/guardians should be informed that if their child's health exam was not completed on the correct form then their child will be required to have the health examination repeated at school by the school district's medical director.

Q: May schools modify the content of the Required NYS School Health Examination Form?
A: The new NYS Required School Health Examination Form is a PDF and may not be modified.

Q: Is there a "fillable" PDF version of the Required NYS School Health Examination Form that a healthcare provider may upload and complete?
A: Yes, the PDF is available as a fillable form (can be found in the resource section of this FAQ).

Q: May schools accept the 2022 or 2023 Required NYS School Health Examination Forms? What is the difference?
A: Yes. Schools may accept either the 2022 or 2023 Required Health Examination Form but should share the most current version with families and providers.
     The 2023 form has appropriate inclusive terms and Dominic Murray SCA information, along with a few other minor updates. 

Q: May the school transcribe the contents from the healthcare provider's form onto the NYS Required School Health Examination Form?
A: No, such practice is considered to be altering a form and is illegal. The healthcare provider must complete and sign the required form or an EHR equivalent form.

Q: Who reviews the health certificate received from the private provider?
A: The School Medical Director

Q: May the Medical Director delegate review of the health certificate to the School Nurse (RN)?
A: 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.

Q: When are health examinations of public school students required by law?
A: 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 

Q: Does a student need a current physical in Pre-K and Kindergarten?
A: 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.

Q. When does the new school year start for students?
A. The term "school year" means the period commencing on the first day of July in each year and ending on the thirtieth day of June next following: Ed Law Article 1 section 2 (15).  Requirements for health examinations and immunizations are based on when the student begins attending instruction.

Q: What date can a school nurse accept as a valid health examination date on a health certificate from the private provider?
A: 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 a fit condition of health to permit his or her attendance in the public schools (Education Law Article 19 §903).

Q: Is there a tool that can help me calculate this easily?
A: 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.

Q: May providers charge for copies of records if not done at the time of the physical?
A: It may be dependent upon the participation status of the provider with that insurer and whether their provider agreement addresses the issue.
If you have been charged a fee personally, you can file a complaint online at New York State Department of Financial Services Consumer Assistance.
Address: 1 Commerce Plaza Albany, NY 12257
Consumer Hotline: 800-342-3736
Outside of NYS: 518-474-6600
Fax: 518-474-2188

Q: May the screening results reported on a health certificate be used and recorded as the mandated screening for the school year?
A: 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. 

Q: May the school medical director delegate vision, hearing, scoliosis, blood pressure, and any other locally determined screening which is part of the health appraisal?
A: 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.

Q: 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?
A: 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 obtain 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 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.

Q: When conducting the physical examination, should another adult be present?
A: The best practice is that another adult, such as the school nurse, is present.

Q: Must the school medical director perform physical examinations (health appraisals) for foreign exchange students or other students who reside outside of NYS?
A: 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.

Q: Is a separate health exam form needed for participation in interscholastic athletics?
A: No separate health exam is required. A valid New York State Required School Health Examination Form signed by a duly licensed physician, PA, or NP who is authorized to practice in NYS can be used.

Q: Who completes the health examination for athletics?
It is at the discretion of the medical director to accept a private healthcare provider’s health examination or to perform the examination of the student. 

A: Ideally, the student’s private healthcare provider (a physician, nurse practitioner, or physician assistant) should perform the health examination. The private provider has knowledge of the student’s family, home, previous illnesses, health history, immunization status, and other background factors to assist in evaluating the total health status of the student. They are also able to order additional tests and institute any necessary therapeutic measures.

*The district’s medical director, who is a physician or NP, is required to perform a health appraisal on students who have not provided the school with a copy of the health examination conducted by a private healthcare provider. (Education Law § 904).

 See Athletic FAQS for other information on Athletics.

Q: How can schools inform parents/guardians?
A: Schools should notify parents/guardians of the upcoming changes via their schools' website, newsletters, back-to-school events, and PTA/PTO. A paper copy of the Required Health Examination Form should be provided to parents/guardians.

Q: How can parents/guardians help their healthcare provider ensure they have the Required NYS School Health Examination Form?
A: Parents/ guardians should bring the approved form to their child's medical appointment so it can be completed at the time of the visit. Some offices charge an additional fee for completing forms after the visit, as this may be considered an additional service.

Q: What resources are available to inform parents/guardians, healthcare providers, and administrators? 
A: To assist schools in notifying and informing parents/guardians and local healthcare providers, we have created the following sample resources. The school medical director and administration should review these resources. The sample resources can be modified as needed to align with local school district needs prior to use. The resources include:

• Instructions for Completion of the New York State School Health Examination EHR Compatible Form
• Instructions for School Nurses and School Medical Directors Related to Completion of the Required Health Examination Form

Q: Who is responsible for notifying healthcare providers of the Required NYS School Health Examination Form?
A: The form was disseminated to healthcare providers through healthcare professional organizations. The NYSDOH shared the form with School-Based Health Centers. However, it is important that school districts and parent groups all collaborate in sharing this information to minimize difficulties for students.

Q: What may parents/guardians/schools do if the healthcare provider refuses to use the NYS Required School Health Examination Form?
A: Parents/ guardians may contact their healthcare insurance company. Parents/ guardians may also choose to find another healthcare provider.

Schools can maintain a log of medical practices that are not using the required form and reach out to them with a copy of the information provided above. We recommend sending a reminder letter to both medical practices and families in early June to ensure that exams performed over the summer are completed using the required form.

Q: May a school accept an electronic health exam form from a private healthcare provider?
A: 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.

Q: Who should healthcare providers contact about adding the Required NYS School Health Examination Form to their Electronic Health Records (EHR) System?
A: Healthcare providers should contact their EHR vendor for assistance.

Q: May a healthcare provider create a form on their EHR that will be accepted as an equivalent to the NYS Required Health Examination Form?
A: Yes, the Education Department and Department of Health worked with healthcare provider organizations to develop the Instructions for Completion of the New York State School Health Examination EHR Compatible Form, which indicates 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. 

Q: May a healthcare provider's office staff electronically sign the EHR equivalent exam form?
A: No, the exam form must be signed by the healthcare provider conducting the examination. Electronic or written signatures from other office personnel including nurses are not acceptable even if they indicate they are signing for the healthcare provider.

Q: May a provider use an electronic signature to sign the health certificate?
A: Yes, 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.

Q: May a healthcare provider staple a completed health exam form (which is not an EHR equivalent) to a blank NYS School Health Examination form to make the exam acceptable?
A: No, the healthcare provider must complete and sign the required form or an EHR equivalent form.

Q: The Health Examination form currently available in the Health Commerce System has not been updated to the Required NYS School Health Examination Form. Can we accept it?
A: Yes, the HCS will be uploading the Required Form soon. If a school receives an exam documented on the HCS form they may accept it for this school year but should provide a copy of the NYS Required School Health Examination Form to providers to educate them about the requirement.

Q: May a public school nurse accept a physical signed by an out-of-state provider?
A: In accordance with New York State statute, full licensure and current registration are required of any professional who practices in New York State. Pursuant to Education Law §6526, the only out of state practitioners that may prescribe medically necessary care/treatment, are physicians licensed in a bordering state and who reside near the border of this state. The border vicinity is usually defined as less than 25 miles.

Q: May a nonpublic school accept a health examination signed by a provider in another state?
A: 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).

Q: What laws cover the confidentiality of school health (education) records?
A: School health records are considered educational records covered under the Family Educational Rights and Privacy Act (FERPA). 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.

Q: How may the school nurse inform appropriate school staff of individual students' health care needs?
A: 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. Need-to-know generally means that a staff member may need to provide care or intervention for a health condition affecting the student. 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 stored in electronic records should have the appropriate safeguards in place to protect confidentiality.

Q: What laws cover the confidentiality of private medical provider records?
A: 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. 

Q: What health records (immunization and health appraisal) should be included when a student transfers to another school?
A: 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 health 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 about record retention under Records Retention | Management | Security Resource page found below in the Resource section.

Q: How long should the Interval Health History for Athletics be kept?
A: The Interval Health History for Athletics 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.

Q: When should dental certificates be requested?
A: Education Law §903 requires public schools to request a dental health certificate at the same time a health certificate/appraisal is required. The dental certificate may be signed by a dentist or dental hygienist. Students will be permitted to attend school regardless of whether or not they have a dental certificate. If the dental certificate is received, it should be filed in the cumulative health record. 

Schools are also required to provide parents, upon request, with a list of dental providers offering free or reduced care.

Q: What are the requirements for Employment Certificates?
A: 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.

Q: What parental/guardian consent is required for health services, treatment, or remedial care of students (other than required health examinations and screenings)?
A: 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 Guidelines for Schools located in the Resource section of this FAQ.

Q: Where can I find BMI/WSC information related to the health certificate/appraisal?
A: Information can be found on the Data Reporting NYSDOH Weight Status Category webpage.

• Guidelines & Memos - Athletics, Health Examination
• Laws & Commissioner's Regulations - Nursing Roles I Practice I Services (Unprofessional Conduct), Health Examinations
• Samples I Forms - NYS Health Examination Form, EHR, Sample Interval Health History, Medical Certificate of Limitations
• Adapted Physical Education | New York State Education Department 
• Athletics Resource Page
• Dental Resource Page
• FERPA Resource Page - Joint Guidance on Application of FERPA and HIPAA to Student Records
• Records Retention Resource Page