Health Forms and Notices

504 Accommodations

Authorization for Release of Health Information Pursuant to HIPAA

Guidelines for Health Services and Section 504 Accommodations (School Year 2024-2025) 

General Medication Administration Form (School Year 2024 – 2025)

Request for Health Services/Section 504 Accommodations Parent Form with HIPAA Authorization (School Year 2024-2025)

Request for Medically Prescribed Treatment (Non-Medication) for (School Year 2024 – 2025)

Medical Accommodations Request Form with Addendum (School Year 2024 - 25)

Parent Letter – 504 Accommodations Reauthorization (School Year 2024 – 2025)

Parent Letter – 504 Accommodations New Students (School Year 2024 – 2025) 

Notice of Non-Discrimination under Section 504

504 Accommodation Plan Template

Remote Learning Addendum to Section 504 Plan

Pre Signature Plan Notice

Diabetes 504 Accommodation Plan Template

504 Team Meeting Scheduled Notice

504 Team Meeting Attendance

504 Accommodations Student and Family Guide

Notice of Eligibility Determination

Guidance on DOE Student After-School/Extracurricular Para & Nursing Requests

Trip Nurse Policy


Medical Room Standards 

CH205 Child Adolescent Health Examination Form

Health Insurance Information in ATS

OT/PT Medicaid Principal Protocol letter

OT/PT Parent Notification Letter


Health Director Contacts

The Facts about Head Lice

Lice Policy Memo

Individual Lice Letter

Class Lice Letter

School Based Health Center Parental Consent Form

School Flu Letter for Parents

Flu Information for Parents

Parents Fight Flu Flyer

Parents Fight Flu Flyer 11 x 17

Travel Health Factsheet for Parents

Allergy and Asthma

Allergies/Anaphylaxis Medication Administration Form (School Year 2024 – 2025)

Asthma Medication Administration Form (School Year 2024 – 2025)

Standing Order for Administration of Epinephrine for Nurses

Training Program for Unlicensed School-Personnel to Administer Epinephrine


Parent Resource: Diabetes Care for Students in DOE Public Schools

Diabetes Medication Administration Form (School Year 2024-2025)

Consent to M.F. External Monitor to Observe Section 504 Team Meeting

Diabetes Team Support Request Form

Bus Driver & Attendant Quick Action Guide 

Completed by school 504 Coordinator, in consultation with the parent and school or OSH nurse, and provided to the student’s bus driver and (if applicable) attendant.

Immunizations and COVID-19 Vaccines

COVID-19 Vaccine Eligibility Letter for Students Ages 5 and Older

COVID-19 Vaccine Eligibility Letter for Students Ages 12 and Older

Guidelines for Entering Student Immunizations into ATS

Health Commissioner Letter to Families Regarding Immunization, April 2024

Immunization Chart for Families

Immunization Guidelines for Schools

Immunization Requirements and Letter

Letter to Parent - Non-immunized Student Marked Absent

Medical Exemption Process for Immunizations

Medical Request for Immunization Exemption

Parent Letter for Students not Fully Immunized, October 2019

Principal Letter for Immunization Policy Update, October 2019

Principal Letter for Immunization Policy Update, June 2019

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  • You can also view the Frequently Asked Questions About Legislation Removing Non-Medical Exemptions from School Vaccination Requirements from New York State Department of Health

Principal Letter to Families Regarding June 30 Immunization Deadline, April 2021

Parent Letters, Policy Change, for Warnings and Exclusions 

Please see the family site for all updates on Immunization Exceptions.

Request for Review of Serology or Documentation of Varicella Disease

    SH88 Parents Exclusion Letter (School Year 2023-2024)

    SH89 Parents Warning Letter (School Year 2023-2024)

    SH65 Medical Immunization Requirements

    Serology Review Process 

    Mental Health

    Mental Health Resource flyer

    Suicide Prevention Flyer

    Mental Health First Aid Handout

    "There's Help All Around You" flyer


    Oral Health

    Dental Services in New York City Schools 

    Available Dental Programs One-Pager

    School-based Health Center Dental Forms

    School-based Health Center Dental Policy and Procedures

    Dental Referral Form

    Mobile Oral Health Programs

    Starting an Oral Health Program

    Picking a Dental Provider

    Picking a Dental Space

    Dental Visit Prep

    Dental Provider Consent Forms

    Columbia DentCare Consent Form

    Ezra Medical Consent Form

    First MedCare Consent Form

    NYU College of Dentistry Consent Form

    NYU Langone Consent Form

    Smile NYC Consent Form

    St. Barnabas Consent Form


    Seizure Medication Administration Form (School Year 2024 – 2025)


    Sexual Health

    Sexual Health Education Parent Notification Letter

    HIV/AIDS Parent Notification Letter: Grades K - 12

    Notifying parents about HIV/AIDS lessons

    Condom Availability Program Parent/Guardian Notification Letter 

    HIVAIDS Parent Notification Letter: Grade 6 - 12

    Notifying parents about HIV/AIDS and Sexual Health Education


    Sports History Form and Recommendation for Participation in Physical Education and Sports

    Substance Abuse

    Drug Myths and Facts

    Frequently Asked Questions (FAQ): E-cigarettes

    Vision Health

    Eye Report and Recommendation Form (E12S)

    Vision Screening Policy Statement

    Vision Screening Handout

    Passive Consent Form

    Vision Pre-screening Letter to Parents 

    Results of Vision Screening Letter

    Results of Vision Screening Follow-Up Letter

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