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 2023-2024) 

General Medication Administration Form (School Year 2023 – 2024)

Request for Health Services/Section 504 Accommodations Parent Form with HIPAA Authorization (School Year 2023-2024)

Request for the Provision of Medically Prescribed Treatment (Non-Medication) for (School Year 2023 – 2024)

Medical Accommodations Request Form with Addendum (School Year 2023 – 24)

Parent Letter – 504 Accommodations Reauthorization (School Year 2023 – 2024)

Parent Letter – 504 Accommodations New Students (School Year 2023 – 2024) 

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 2023 – 2024)

Asthma Medication Administration Form (School Year 2023 – 2024)

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 2023-2024) - Updated September 2023

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

Health Commissioner Letter to Families Regarding Immunization, April 2024

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

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

  • English
  • 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

Parent Letters, Policy Change, for Warnings and Exclusions 

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

Letter to Parent - Non-immunized Student Marked Absent

SH88 Parents Exclusion Letter (School Year 2023-2024)

SH89 Parents Warning Letter (School Year 2023-2024)

Immunization Chart for Families

Immunization Guidelines for Schools

SH65 Medical Immunization Requirements

Medical Exemption Process for Immunizations

Medical Request for Immunization Exemption

Medical Request for Immunization Exemption for COVID-19 Vaccine

Request for Review of Serology or Documentation of Varicella Disease

Serology Review Process 

Guidelines for Entering Student Immunizations into ATS

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 2023 – 2024)

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 Screening Letter to Parents

Results of Vision Screening Letter

Results of Vision Screening Follow-Up Letter

Back to Top