**NYSED Website link with complete instructions in 2023
School Health Examination Form
Note: If a provider checks the box “Systems Review and Abnormal Findings Listed Below” but does not check each system box to indicate “reviewed,” they are indicating all systems were reviewed and normal. You may clarify with the provider that this is how they will be completing the health exam form. Make a note of this so that in the future anyone reviewing the forms in the future is aware of the practice in that healthcare provider’s office.
Required NYS School Health Examination Form (PDF NYSED 2023)
This form may be printed and completed by hand.
Required NYS School Health Examination Form (Fillable PDF NYSED 2023)
This form may be completed electronically by saving it to your computer, entering the information into the fillable fields, and saving a copy for each student.
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