Click here for additional resources on our Samples|Forms|Notifications page.

This NYSED memo communicated NYSED is working with medical providers through their professional

organizations to develop a format that can be utilized in electronic health record systems.

Until further notice, you should continue to accept any health exam form received. NYSED will

disseminate information in the coming months regarding changes to the

form along with when it will be required.

STAY TUNED FOR UPDATES!

Health Examination Resources for Schools

School Health Examination Guidelines 2018
Provides information on student health examination requirements and guidance for administrators and school health personnel in establishing the mandated health program. (Updated May 2018)

Required NYS School Health Examination Form Effective 7/1/18
This form should be completed by the private health care provider or school medical director to document health examinations. The form may be printed and completed by hand or completed electronically by saving it to your computer, entering the information into the fillable fields and saving a copy for each student. (Updated 5/4/2018 to correct proper spelling of HbA1c)
The Required NYS School Health Examination Form is not available in word format for schools to customize or alter.

Sample Recommended NYSED Interval Health History for Athletics
Completed by parent/guardian no earlier than 30 days prior to the start of the sport.(Updated, 3/2018) Fillable PDF

Sample Recommended NYSED Interval Health History for Athletics
Completed by parent/guardian no earlier than 30 days prior to the start of the sport.(Updated, 3/2018) Word Doc

Sample Recommended Form-Medical Certificate of Limitations
Used to document private provider recommendations for accommodation for PE (Updated May 2018).

Sample Athlete with Special Needs Supplemental History Form
This resource from the American Academy of Pediatrics may be helpful in collecting additional health information from athletes with special needs. (AAP-Bright Futures, 3/2018)

Health Exam FAQs

2018-19 Specific FAQs- Health Examinations
General FAQs - Health Examinations 

Dental Certificates

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

Click the link below for Screening Resources on the Guidelines and Memos Page

NYS Education Department Screening Guidelines and Memos for Hearing, Scoliosis, and Vision includes guidelines, screening forms, School Health Exam/Screening Chart, sample parent notification and referral forms, sample teacher observation forms, documentation and tracking forms.

Page updated 1/24/19