Forms
Physical and Dental Forms
All health examinations must be on the required NYS Health Examination form or an electronic health record equivalent form.Physical Exam
Health History
Dental Form
Medication Forms
Medication Administration Orders
Independent Carry and Use Medication Orders for Grades 6-12
Independent Carry and Use Rapid-Acting Rescue Medication Order Grades K-5
Healthcare Provider Attestation
KI Refusal/Opt-Out
Activity Restriction Forms
Elementary School PE Modification
Secondary School PE Modification (Generic)
Secondary School PE Modification (Sport-Specific)
Secondary School Building Level Clearance/Modifications
Immunization Exemption Forms
NYS requires a valid, specific medical exemption that must be signed by a NYS physician for school-aged children. Exemptions must be renewed annually and specify the contraindication and for how long. Immunization exemptions must be filled out on the official NYSDOH form.
