Student Health Examinations Form Update as of 2-1-21

The New York State Department of Education requires a health certificate or health appraisal of each public school student when they: enter the school district for the first time; are in Grades K, 1, 3, 5, 7, 9 and 11; participate in interscholastic sports; need working papers; and are referred to the Committee on Special Education.

Effective 2/1/21, all health examinations performed for school must be documented on the NYS Required Health Examination Form or an electronic health record equivalent form - pursuant to Education Law.

ONLY the approved form or an electronic health record equivalent form will be accepted by schools for health examinations conducted on or after 1/31/2021.
Students who present a physical exam that is not acceptable will be required to have the parent/guardian contact your office to complete the correct form.

Click here to view/download the required New York State form.

Please note the components on the health exam form are required in NYS Law. The Instructions for Completion of New York State School Health Examination Form provides direction to healthcare providers on the required components and the required presentation order of those components for an electronic health record form to be an equivalent form.

This information is also on the NYS Center for School Health website at www.schoolhealthny.com.