Health Forms and Notices

504 Accommodations

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

General Medication Administration Form (School Year 2019 - 2020)

Request for the Provision of Medically Prescribed Treatment (Non-Medication) for School Year 2019 - 2020

Parent Request for Section 504 Accommodations with HIPAA Authorization Form (School Year 2019 - 2020)

Medical Review for 504 Accommodations (School Year 2019 - 2020)

Medical Accommodations Request Form (School Year 2019 - 2020)

Parent Letter – 504 Accommodations New Students

Parent Letter – 504 Accommodations Reauthorization

Notice of Non-Discrimination under Section 504

504 Accommodation Plan

504 Accommodations Student and Family Guide

Notice of Eligibility Determination

Authorization for Release of Health Information Pursuant to HIPAA (School Year 2019 - 2020)

General

CH205 Child Adolescent Health Examination Form

New Admission Examination Notice, with FAQ

New Admission Examination Appointment Notice, with FAQ

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

Parent Letter for Guidance for EpiPen Shortage

Allergies/Anaphylaxis Medication Administration Form (School Year 2019 - 2020)

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 2019-2020)

      Diabetes

      Diabetes Medication Administration Form (School Year 2019 - 2020)

      Diabetes Medication Administration Form Addendum (School Year 2019 - 2020)

      Diabetes Medication Administration Form Parent Letter (School Year 2019 - 2020

        Immunization

        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 Parents About Immunizations

        Last updated September 2019

        Letter to Parents About Immunizations from June, 2019

        Letter to Parent - Non-immunized Student Marked Absent

        English

        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 Consultant Program Backpack Letter

                      Suicide Prevention Flyer

                      Making Educators Partners Handout

                      Mental Health First Aid Handout

                      "There's Help All Around You" flyer

                      Mental Health Resource flyer

                      Oral Health

                      School-based Health Center Dental Policy and Procedures

                      Dental Referral Form

                      Dental Visit Prep

                      Picking a Dental Provider

                      Picking a Dental Space

                      Starting an Oral Health Program

                      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

                      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

                      History Form: Pre-participation Physical Evaluation

                      For medical provider's records only.

                      Recommendation for Participation in Physical Education and Sports

                      Give to student to return to coach

                      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

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