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Health examination for all students entering the school district for the first time and when entering Pre-K or K, 1st, 3rd, 5th, 7th, 9th , and 11th grade.

New York State law requires a health examination for all students entering the school district for the first time and when entering Pre-K or K, 1st, 3rd, 5th, 7th, 9th , and 11th grade.

The examination must be completed by a New York State licensed physician, physician assistant or nurse practitioner and on the approved NYSED Student Health Examination Form for School.

A dental certificate which states your child has been seen by a dentist or dental hygienist is also asked for at the same time.  If you do not have a dentist you can use our dental program at school.  You will have to sign up for this program when the forms are sent home in the fall.

  • A copy of the health examination must be provided to the school within 30 days from when your child first starts at the school, and when your child starts K , 1st , 3rd, 5th, 7th, 9th,  & 11th grades. If a copy is not given to the school within 30 days, the school will contact you.
  • If your child has an appointment for an exam during this school year that is after the first 30 days of school, please notify the Health Office with the date.
  • For your convenience, a physical exam form and dental certificate for your health care providers is enclosed.
  • Communication between private and school health staff is important for safe and effective care at school. Your healthcare provider may not share health information with school health staff without your signed permission. Please talk to your provider about signing their consent form for the school at the time of your child’s appointment for the examination. 

 We suggest you make copies of the completed forms for your own records before sending them to the school health office. Forms may also be faxed to 585-567-2541 or emailed to sparmenter@fillmorecsd.org

Required NYS School Health Examination Form

Tdap and Meningococcal Vaccine Information