Voice Recognition

FORMS

Physical Form

 NEW! As of July 1, 2018 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. These examinations must be completed on the approved NYSED Student Health Examination form for the health exam. We understand that your medical provider ‘s office may not yet be aware of the changes, so if you already had a physical exam completed for the 2018-19 school year on a different form, the school may accept the physical for this school year on that form. A dental certificate which states your child has been seen by a dentist or dental hygienist is also asked for at the same time. For your convenience, a physical exam form and dental certificate for your health care providers is enclosed. In addition, the approved NYSED student health exam form for schools can be found on the CF District site, under departments, choose health services and go to forms or under the heath office of each building.

 

 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 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. If a copy is not given to the school within 30 days and we have not heard from you, the school will schedule a health exam with the schools medical director.

Medication Form + SEVERE ALLERGY INDICATOR (EPI PEN) Form

No medication (prescribed or over the counter) may be administered to a child in school without a written order from a physician indicating the medication, dosage, frequency and duration of treatment. This needs to be accompanied with a parent consent, signed and dated. All medication needs to be given to the nurse by an adult, in a pharmacy labeled prescription bottle or the original over the counter container.  Students should NOT bring any medication to school on the bus or in their backpacks.

In addition, if a student requires medication for SEVERE ALLERGY, we also need the SEVERE ALLERGY form filled out by your medical provider.  If the allergy is food please also utilize the diet prescription form.

Self- carry Inhaler Form

Self directed students who plan to carry their own inhaler with them will have to have this form signed by their physician.

Diet Prescription Form

Have Your physician fill out this form for any dietary restriction or modification needed.
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