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)

NYSED Guidelines

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.

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

Health Exam and Screening Requirements Charts|Determination for Ungraded Students

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

Chronological Grade Level Chart 2019-2020 for ungraded classes (3/2019)

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. 

NYSED List of Dental Providers Offering Free or Reduced Care (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 (4/2018).

Sample Parent Notification/Request for Mandated Health Appraisal and notification of medical director providing health appraisal if not provided by private health care provider. (1/9/20)

Forms for Recording Health Examinations

NYS School Health Examination FormCompleted 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 Recommended NYSED Interval Health History for Athletics-Completed by parent/guardian no earlier than 30 days prior to the start of the sport. (3/2018).

Sample Recommended Form-Medical Certificate of Limitations-Completed by the private provider to document recommendations for PE accommodations. (5/2018).

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) 

Updated: 1/9/20