Health Examination & Dental Forms | Parent Letters | Notifications

To access the 2017-18 Health Examination Guidelines or form contact the Center at nyscsh@monroe2boces.org. 

Health Examination Resources for Schools

School Health Examination Guidelines 2018Provides information on requirements and guidance for administrators and school health personnel in establishing the mandated health program. (Updated May 2018) This link redirects to the NYSED Guidelines and Memos by Content Area page under Health Examination. Note: Dental exam grade levels align with health exam grade levels. 

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
Health history to be completed by parent/guardian no earlier than 30 days prior to the start of the sport. Revised (Two Page Form, Updated 3/2018)

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 Form
Resource from American Academy of Pediatrics that may be helpful in collecting additional health information from athletes with special needs. (AAP-Bright Futures, 3/2018)

Sample Medical History Update Form 
The optional form that may be used to obtain current health information from the parent/guardian in non-mandated health examination yeas or to provide student history prior to a school provided physical exam (2/18) 

Sample Individual Student Health Office Visit Record (8/12) 

Sample Student Cumulative Health Record (3/18)

Sample Athlete with Special Needs
This additional resource from American Academy of Pediatrics (AAP) may be helpful in collecting important information for athletes with special needs. (3/2018)

Health Exam FAQs-Are located on the Health Exam Page in A-Z. Click here to view them. 

2018-19 NYS & NYC Screening & Health Examination Requirements Chart Effective 7/1/2018.

Chronological Grade Level Chart

Chronological Grade Level Chart 2018-2019 This chart should be used to determine immunization, health exam/dental, and screening requirements for students in gradeless classrooms. Students need to meet the grade level requirements based on their date of birth.

Dental Certificate|Dental Providers|Letter to Parents/Guardians Regarding Dental Exams

Sample Dental Certificate-NYSED
NYS law (Chapter 281) permits schools to request an oral health assessment when requesting the health exam. It may be completed by a registered dentist or NYS registered dental hygienist. This form was updated to include dental hygienists (5/18).

NYSED List of Dental Providers Offering Free or Reduced Care (Updated 4/28/2017)

Letter to Parents Regarding Health and Dental Examination Requirements. 
Informs parents/guardians of the mandated requirements for health appraisal within 30 days of school entry (4/18).

2018-19 Health Examination Transition Information for Schools
Section 136.3 Health Examinations and Screenings changes are effective 7/1/18. Health examinations for attendance will be required for new entrants and in grades Pre-K or K, 1, 3, 5, 7, 9, and 11.

  • The new NYS School Health Examination Form is not required for physicals done prior to 7/1/18.
  • To assist with the transition, during the 2018-2019 school year schools may accept any health examination form provided.  
  • In 2019-2020 ONLY the approved form will be accepted. 

Sample Letters
The customizable resources below may be used to inform parents, guardians and health care providers of the new school health examination requirements.

Sample Letter to Parent/Guardian and Health Care Provider Regarding Health Examination Changes and Requirements.
Explains the regulation and what is required for the 2018-19 school year.

Information for Public School regarding Changes in Health Examination and Screening Requirements
Provides a transition plan for the 2018-19 school year. *The new NYS School Health Examination Form is not required for physicals done prior to 7/1/18.

Sample Delegation
 
 
Updated: 6/26/18