Health Examination | Forms | Guidelines

Beginning 1/31/21 physical examinations for school are to be documented on the
NYS Required Health Examination or an electronic health record equivalent form. New resources and FAqs are below!

The Sample NYSED Interval Health History Form has been updated to include questions related to COVID-19.

Click here for additional resources (including Required Health Exam Resources) on our Samples|Forms page.

NYSED Memos Regarding Requirement Changes Due to COVID-19

NYSED Memo: School Health Examination in Light of COVID-19 Pandemic -12/17/2020The Department is again extending the requirements for a health exam for school attendance and participation in interscholastic athletics. (NYSED December 2020)

NYSED Memo: School Health Examinations in Light of COVID-19 Pandemic (5/21/20)
Requests schools accept any physical examination form for physicals conducted on or before 1/30/2021, regardless of the form used (NYSED 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. 
(NYSED Updated May 2018)

FAQs - Health Examinations 

School Health Examination Forms

Required NYS School Health Examination Form 
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). 

NYSED Instructions for Completion of New York State School Health Examination Form
Provides direction to healthcare providers on the required components and the required presentation order of those components for an electronic health record form to be an equivalent form. (NYSED, 2020).

Required NYS School Health Examination Sample Resources

Contains instructions for school nurses and school medical directors and customizable, sample notifications for parents/guardians and community health care providers reminding them of the need to use the required form. (NYSCSH 1/24/21)

FAQs-NYS Required Health Examination Form (1/26/21)

Interval Health History Forms-This form may be modified by local school districts. If modified, it should be reviewed and approved by the School Medical Director and Administration prior to use.

Sample Recommended NYSED Interval Health History for Athletics- Completed by parent/guardian no earlier than 30 days prior to the start of the sport. This form now includes questions related to COVID-19 (Fillable PDF Updated, 12/2020) 

Sample Recommended NYSED Interval Health History for Athletics- Completed by parent/guardian no earlier than 30 days prior to the start of the sport. This form now includes questions related to COVID-19 (Word Updated 12/2020)

Spanish Sample Recommended NYSED Interval Health History for Athletics (Word Updated 1/2021)

Note: The American Academy of Pediatrics (AAP) has released updated guidance on sports participation for students following COVID-19. School medical directors may request additional information from the parent/guardian or request consent from the parent/guardian to speak with the private health care provider in order to provide clearance to participate or determine if accommodations are needed. Schools may request additional information they may not require that students see specific types of providers or specific tests. That is determined by the private health care provider. (12/4/20)

Certificate of Limitations Form

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

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)

Dental Certificates

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

Screening Resources are located 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 1/26/21