Health Examination | Forms | Guidelines
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, 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 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 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)
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
The form may be printed and completed by hand. (PDF NYSED 2020). - 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
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. (Accessible Word document, NYSED 2020).
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
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.
Spanish Sample Recommended NYSED Interval Health History for Athletics (Word Updated 1/2021)
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)
Screening Resources are located on the Guidelines and Memos Page
Page Updated 3/21/21