Student health examination requirements

Dear Parents/Guardians,

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.

  • 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 Pre-K or 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 for your health care provider is available by clicking here (PDF).  If your child had an exam after January, 2021, the school can only accept this required New York State Health Examination Form, which must be filled out by a doctor. 
  • 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 the number below.


School Nurse: Lori Anderson, RN
School: Herkimer Jr/Sr High School
Phone: 315-866-2230. ext. 1322
Fax: 315-866-2243


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