Health Examination & Dental Forms | Parent Letters | Notifications
1/2019 Per NYS Education Department:
Until informed otherwise, public schools may use any health exam form approved by their district.
Health examinations are required for new entrants and in grades Pre-K or K, 1, 3, 5, 7, 9, and 11.
(Section 136.3 Health Examinations and Screenings. Effective 7/1/18)
School Health Examination Guidelines 2018 (Updated May 2018)
Provides information on requirements and guidance for administrators and school health personnel in establishing the mandated health program. This link redirects to the NYSED Guidelines and Memos by Content Area page.
Required NYS School Health Examination Form (Dated 2020)
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. To make sure the version of the form you are using is correct be sure it has 2020 in the footer. Note: Until 1/30/21, schools may accept any health examination regardless of the form it is on.
Health Exam and Screening Requirements Charts|Determination for Ungraded Students
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). Dental exam grade levels align with health exam grade levels.
Forms for Recording Health Examinations
NYS School Health Examination Form- Completed by the private health care provider or school medical director. 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
Sample Athlete with Special Needs Supplemental Form-American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.PDF (2010)
Sample Medical History Update Form -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 (2/2018)
Health Office Daily Visit Logs and Cummulative|Summary Records