Health Forms and Documents
Each of the following forms are PDF documents.
Health and Wellness
An “Emergency Health Information Form” is sent home to parents in late August/early September. Parents are required to provide emergency contact information, which may include friends or relatives to be called in case of illness or injury if the parents cannot be reached. This form gives the school written permission to call the emergency contact(s) listed, as necessary. It is important to inform the school in writing of changes to contact information. If you cannot be contacted, the school may not release your child to anyone other than the person or persons listed in case of emergency.
Parents are also required to provide updated health information on Page 2, (the reverse side). This includes allergies, medications, (both prescription and over-the-counter medications), and recent health information. This health information is kept on file by the nurses only.
New York State Education Department Guidelines state that ALL medications, including over-the-counter medications, given at school, require the following:
• A written order from your child’s physician stating the name of the medication, dosage, frequency and time of administration;
• Written statement from the parent or guardian requesting administration of the medication in school; and
• Delivery of the medication to the health office by parent or guardian in a properly labeled “original” / pharmacy container. Elementary students are NOT allowed to carry medications to and from school.
At the secondary level, emergency medications such as epi-pens and inhalers can be carried by those students who are determined to be self-directed with written orders from the student’s medical provider.
A physical exam is required for all children entering this school system for the first time and for all children entering grades K, 2, 4, 7 and 10. Proof of this exam must be a signed physician’s physical appraisal form. [A physical exam performed within the 12 months prior to the start of the school year is acceptable. All forms are due by October.] If such an examination is not provided, the school is required by law to provide the exam at the school’s expense. We prefer that parents make appointments to have the family doctor complete the physical as he/she will perform a more complete physical exam and will give the required immunizations.
Recent changes to the New York State Education Law require that body mass index (BMI) and weight status category be included as part of the student’s required school health examination. The BMI helps the student’s medical provider know if the student’s weight is in a healthy range or is too high or too low. School districts are required to submit summary information on weight status category to the New York State Department of Health to help health officials develop programs to improve children’s health. No personally identifiable student information will be sent. Parents may choose to have their child’s information excluded from this reporting.
Section 2164 of the New York State Public Health law requires that parent(s) provide evidence of their child’s vaccination status before he/she can be admitted to school. The following immunizations are required:
• 3 OPV or IPV (polio vaccine).
• 3 DPT, DTaP, or DT (diphtheria-pertussis-tetanus vaccine). Full doses only.
• 1 Tdap (Tetanus, Diptheria, and Pertussis Booster) for all children born on or after 01/01/94 who enroll in sixth grade and are 11 years old.
• 1 Measles vaccine (after first birthday).
• 1 Mumps vaccine (after first birthday).
• 1 Rubella vaccine (after first birthday).
• 1 Measles booster (after 15 months) for all children born on or after 01/01/1985.
• 3 Hepatitis B vaccine for all children born on or after 01/01/1993 and all students entering seventh grade on or after September 2000.
• 1 Varicella vaccine (after first birthday) for all children born on or after 01/01/1998 and all children born on or after 01/01/1994 who enroll in sixth grade, or physician documentation regarding history of disease.
Evidence of the above immunizations must be in the form of a written certificate or record from the physician’s office. Children who do not meet the State requirement will be denied admission into school until they are designated “in process”.
Public Health Law also states that immunizations are not required where the parent(s) or guardian(s) “hold genuine and sincere religious beliefs” which are contrary to immunization. If this applies to you, please contact the school for the “Request for Religious Exemption to Immunization Form, Parent Guardian Statement”, from The University of the State of New York and The State Education Department. As per NYS law, the building principal may ask for further supporting documents to review when considering the religious exemption. Please contact your school nurse with any questions or concerns.
Please contact your school nurse if a medical exemption is required.
New York State Education Law 903, Chapter 281, permits schools to request a dental examination report for all newly enrolled students, and for students in grades K, 2, 4, 7, and 10. Dental Health Certificates are to be completed by parent or guardian and the child’s dentist. Completed certificates should be sent to your school nurse.
New York State Education Law, (Article 19, Section 905), and the Commissioner’s Regulations, Section 136.3, requires that schools provide the following health screenings:
• Vision screening for all newly enrolled students, including color perception, distance acuity, near vision, and hyperopia; in addition, all students in grades K, 1, 2, 3, 5, 7, and 10, will be screened for distance acuity.
• Hearing screening for all newly enrolled students, as well as for students in grades K, 1, 3, 5, 7, and 10.
• Scoliosis screening for all students in grades 5 through 9
Parent(s) will be notified if there are any concerns during their child’s screening. Results of all screenings will be documented in the student’s school health record.
All students who are ill or injured must be dismissed through the health office. Students are encouraged to report to the health office any illness or injury that occurred at school. This will ensure proper care and insurance claim processing.
The facilities in school are not designed to take care of ill or injured students for any length of time. Parents are expected to make arrangements to have their ill or injured child picked up at school.
The district carries accident insurance for all students in grades K-12. The insurance plan provides excess, or secondary, coverage. In the event of accidental injury to a student, parents should first submit the claim to their own health and accident carrier. If the claim is not payable or is in excess of the coverage provided, the remainder is submitted to the school plan for payment.
Interested students must sign up to participate in the athletics program through the health offices at the middle and high schools. The following forms are required to play a sport:
• Sport’s Update form for every season (to be completed by parent); and,
• Current physical exam. (Additional information may be requested such as illness/injury clearance).
If parents or students have any questions, (ie. deadlines, etc), please contact your school nurse.