Health Examination | Forms | Guidelines
New NYSED MEMO on Health Examinations In Light of COVID-19 Released 5/20/21 Below!
As of 1/31/21, the NYS Required Health Examination or EHR compatible form is required.
The Center does not review electronic equivalent forms.
Sample notifications, a webinar, and FAQs regarding this requirement are below.
The Sample NYSED Interval Health History Form has been updated to include questions related to COVID-19.
NYSED Memos Regarding Requirement Changes Due to COVID-19
NYSED Memo: School Health Examination in Light of COVID-19 Pandemic (5/20/21)
Effective May 11, 2021 students who are unable to obtain a health examination in the required grade have until September 1, 2021, to obtain the required health examination. Medical directors may choose to postpone completing health examinations until after December 31, 2021, for students who do not provide a health certificate for the 2021-2022 school year.
NYSED Memo: School Health Examination in Light of COVID-19 Pandemic
The Department is again extending the requirements for a health exam for school attendance and participation in interscholastic athletics. (NYSED 12/17/2020)
NYSED Memo: School Health Examinations in Light of COVID-19 Pandemic
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 sport (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)
School Health Examination Form
Note: If a provider checks the box “Systems Review and Abnormal Findings Listed Below” but does not check each system box to indicate “reviewed,” they are indicating all systems were reviewed and normal. You may clarify with the provider that this is how they will be completing the health exam form. Make a note of this so that in the future anyone reviewing the forms in the future is aware of the practice in that healthcare provider’s office.
- Required NYS School Health Examination Form (PDF NYSED 2020).
The form may be printed and completed by hand.
- Required NYS School Health Examination Form (Fillable PDF NYSED 2020)
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 (NYSED 2020).
- Required New York State School Health Examination Form (Accessible Word Document - Read Only, NYSED 2/2021)
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 This copy is accessible to those using a screen reader.
Instructions for an EHR Compatible Form
Instructions for Completion of the New York State School Health Examination EHR Compatible 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). Posted 1/28/21
School Health Examination Form Sample Resources and Webinar
Instructions for School Nurses and School Medical Directors Related to Completion of the Required Health Examination Form Effective 1/31/2021
Contains instructions and customizable, sample notifications for parents/guardians and community health care providers reminding them of the need to use the required form (NYSCSH 3/3/21)
Zoom Recording on the Required NYS School Health Examination Form
This Zoom discussion recording shares information regarding implementing the Required NYS School Health Exam for physical exams performed on or after 1/31/21. It reviews resources available to educate families and health care providers, including the new FAQ, which addresses using the 20-21 school year to educate families and providers about the requirement (NYSCSH 2/4//21, 25 minutes).
Interval Health History Forms-This form may be modified by local school districts. If modified, the School Medical Director and Administration should review and approve it before use.
- Sample Recommended NYSED Interval Health History for Athletics- Completed by parent/guardian no earlier than 30 days before 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 before 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 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 Limitations- Used 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 should be requested along with Health Examinations but are NOT required for school attendance.
NYS Education Department Screening Guidelines and Memos for Hearing, Scoliosis, and Vision include guidelines, screening forms, School Health Exam/Screening Chart, sample parent notification, referral forms, sample teacher observation forms, documentation, and tracking forms.
Page Updated 7/14/21