School Health Forms

Emergency Blue Card

Please fill out the Emergency Contact Information form to ensure we have the most updated information for your child.

Family Income Inquiry Form

Please complete the NYC DOE Family Income Inquiry Form using the link below. If you have any questions, please reach out to our Parent Coordinator, JC DiCicco at jdicicco@schools.nyc.gov

 

Family Income Inquiry Form

DOE Health Screen Links

DOE Health Screening Links for Families: Complete the health screening either online or using the paper form

https://healthscreening.schools.nyc/docs/DOE_Health_Screening_Questionnaire_090420.pdf.

Health Form Videos

Health Services/Section 504 Accommodations 

The Office of School Health manages the processes surrounding students needing medication administration, medically-prescribed treatment, glucose monitoring, insulin pump maintenance, and other Section 504 and Individualized Education Program (IEP) services.

Several health forms are used in the New York City public schools. Using these forms helps assure that children get the care, services, and accommodations they need during the school day.

The following forms can be downloaded, completed by parent/guardian and physician/health care provider, and submitted to the child's school.(Forms must be printed and completed by hand, not on-line.) 

504 FAQs
 
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Guidelines for the Provision of Health Services and/or Section 504 Accommodations for Students
    
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1) Asthma Medication Administration Form (AMAF) including Parent/Guardian's Consent, Authorization and Release 

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2) Allergies/Anaphylaxis Medication Administration Form (AAMAF) including Parent/Guardian's Consent, Authorization and Release

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3) Medication Administration Form (MAF) including Parent/Guardian's Consent, Authorization and Release

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4) Request for Provision of Medically Prescribed Treatment (Non-Medication)

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5)  School Diabetes Medication Administration Form (DMAF) including Parent/ Guardian's Consent, Authorization and Release

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6) Request for Section 504 Accommodations: NEW - the Request form is now in 2 parts:
        6a. Request for Section 504 Accommodations with HIPAA Authorization: This form is to be completed by the Parents

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        6b. Medical Review for 504 Accommodations 2016-2017: This form is to be completed by a Medical Practitioner