Cumulative Record|Visit Logs|Screening Charts | Forms | Letters | Notifications

SCREENING FORMS, CHARTS

New NYS & NYC Screening & Health Examination Requirements Chart- Effective 7/1/2018. Dental certificate requests should align with the new health exam grade levels (Created 1/2018) 

Letter to Parent Regarding Required Screening for Vision, Hearing, Scoliosis, Health Examinations. (12/2018)

HEARING

Hearing Screening Parent/Guardian Notification Results and Referral Form (5/2018)

Classroom Teacher Observations- Hearing (5/2018)

SCOLIOSIS

Scoliosis Screening Parent/Guardian Notification Results and Referral Form(5/2018)

VISION:

Vision Screening Parent/Guardian Notification Results and Referral Form (10/2018)  
Note: Parents must be notified of both passing and failing vision results. If a student passes it is sufficient to just indicated passed. However, if they fail you should provide the findings so the follow-up provider has a frame of reference. This form allows you to provide that information.

Classroom Teacher Observation - Vision (5/2018)

Sample Delegation

Updated 1/10/20