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NYS School Health Exam Form

For completion by a health care provider licensed to practice in New York State. This form must be completed for the following grades in elementary school, Pre-K or K, 1st, 3rd, & 5th. It must also be completed for all new students to the district and if your child is evaluated by the Committee for Special Education. 

Related Files

  • Student Health History Form

    To be completed by parent or guardian. Please list your all of your child's health conditions and current medications. If your child has severe allergies and/or anaphylaxis, please contact the school nurse to ensure that she is aware.

  • Dental Health Certificate

    To be completed by your child's dentist. This form is OPTIONAL in New York State at this time.

  • Release of information form

    To be completed by parent guardian. Please complete this form to permit communication between the school & your child's health care provider.

  • Parent and Prescriber's Medication Permission Form

    To be completed by health care provider and parent. This form must be completed prior to administration of any medication, either prescribed by MD or over the counter (OTC). MD orders for medications may also be faxed directly to the health office at 518-297-4424.

  • Student Health & Medication Update Form

    To be completed by parent/guardian yearly or more often if there have been changes to your child's health or medication schedule. Please contact the school nurse any time there are changes to your child's health.