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.
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-Resource from the 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 -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)
Logs and Summary Records