Health Forms and Notices

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504 Accommodations

Guidelines for the Provision of Health Services and/or Section 504 Accommodations (School Year 2021 – 2022)

Guidelines for the Provision of Health Services and/or Section 504 Accommodations

General Medication Administration Form (School Year 2021 - 2022)

General Medication Administration Form (School Year 2020 - 2021)

Request for the Provision of Medically Prescribed Treatment (Non-Medication) for (School Year 2021 – 2022)

Request for the Provision of Medically Prescribed Treatment (Non-Medication) for School Year 2020 - 2021

Parent Request for Section 504 Accommodations with HIPAA Authorization Form (School Year 2021 – 2022)

Parent Request for Section 504 Accommodations with HIPAA Authorization Form (School Year 2020 - 2021)

Medical Accommodations Request Form (School Year 2021 – 2022)

Medical Accommodations Request Form (School Year 2020 - 2021)

Parent Letter – 504 Accommodations New Students

Parent Letter – 504 Accommodations Reauthorization

Notice of Non-Discrimination under Section 504

504 Accommodation Plan Template

Remote Learning Addendum to Section 504 Plan

Pre Signature Plan Letter

Diabetes 504 Accommodation Plan Template

504 Team Meeting Scheduled Letter

504 Team Meeting Attendance

504 Accommodations Student and Family Guide

504 Coordinator Training

Notice of Eligibility Determination

Authorization for Release of Health Information Pursuant to HIPAA (School Year 2021 – 2022)

Authorization for Release of Health Information Pursuant to HIPAA (School Year 2020 - 2021)

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

General

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

AED

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

Travel Health Factsheet for Parents

Allergy and Asthma

Allergies/Anaphylaxis Medication Administration Form (School Year 2021 – 2022)

Allergies/Anaphylaxis Medication Administration Form (School Year 2020 - 2021)

Allergy Response Plan

Medical Review of Student with Severe Allergies

Standing Order for Administration of Epinephrine for Nurses

Training Program for Unlicensed School-Personnel to Administer Epinephrine

Asthma Medication Administration Form (School Year 2021 – 2022)

Asthma Medication Administration Form (School Year 2020-2021)

Diabetes

Diabetes Medical Administration Form Reauthorization Letter (School Year 2020 - 2021)

Diabetes Medication Administration Form (School Year 2021 – 2022)

Diabetes Medication Administration Form (School Year 2020 - 2021)

Diabetes Team Support Request Form

Immunizations and COVID-19 Vaccines

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

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

English

SH89 Warning Notice

Arabic, Bengali, Chinese, English , French, Haitian Creole, Korean, Russian, Spanish, Urdu

SH88 Notice of Exclusion

Arabic, Bengali, Chinese, English, French, Haitian Creole, Korean, Russian, Spanish, Urdu

Immunization Chart for Families

Immunization Guidelines for Schools

SH65 Medical Immunization Requirements

Medical Exemption Process for Immunizations

Medical Request for Immunization Exemption

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

NY Foundling Consent Form

NYU College of Dentistry Consent Form

NYU Langone Consent Form

Smile NYC Consent Form

St. Barnabas Consent Form

Seizure

Seizure Medication Administration Form (School Year 2021 – 2022)

Seizure Medication Administration Form 2020-21

Sexual Health

Sexual Health Education Parent Notification Letter

HIV/AIDS Lessons Opt Out Letter for Parents

HIV/STI Prevention and Birth Control Opt Out Letter for Parents

Sports

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

Eye Report and Recommendation Form (E12S)

Vision Screening Policy Statement

Vision Screening Handout

Vision Screening Letter to Parents

Results of Vision Screening Letter

Results of Vision Screening Follow-Up Letter