PLEASE READ THE NYSCSH CLARIFIFICATON OF SCHOOL HEALTH EXAMS BELOW
BEFORE CONTACTING THE CENTER WITH QUESTIONS

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

NYSED Memo: School Health Examinations in Light of COVID-19 Pandemic (5/21/20)
Requests schools continue to accept any physical examination form from students for physicals conducted on or before January 30, 2021, regardless of the form used (5/21/20).

NYSCSH Clarification of School Health Examinations in Light of COVID-19 Pandemic 
Provides additional information on acceptable health exams for school entry, mandated years, interscholastic sports (including AAP), CSE/CPSE, and working papers. (NYSCSH 6/4/20)

School Health Examination Guidelines 2018

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)

School Health Examination Forms

Required NYS School Health Examination Form 
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 (NYSED, 2020). 
Note: Make sure the version of the form you download and use has 2020 in the footer.

NYSED Instructions for Completion of New York State School Health Examination Form
This instruction sheet was created to assist providers in filling out in completion of the Required NYS School Health Examination Form in entirety.( NYSED, 2020)

Interval Health History Forms

• 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

Medical Certificate of Limitations Form

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

Athlete with Disabilities Form

• 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. (AAP-Bright Futures, 2019)

Health Exam FAQs

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 include guidelines, screening forms, School Health Exam/Screening Chart, sample parent notification and referral forms, sample teacher observation forms, documentation, and tracking forms.

Page updated 9/21/2020