Medical Forms

Jump to: NYC Health Requirements for School Entrants

Click below to download a medical form:

Child & Adolescent Health Exam Form

Frequently Asked Questions

1) How often do I need to submit documentation of a physical exam?
The NYC Department of Health requires all children to submit documentation of a current physical exam on an annual basis. All forms need to be signed and dated by your physician.

2) Is there a different form for camp and school?
No, it is the same form. For example, if you submit a form for summer camp with a June date, you do not need to submit any updates for school or camp until the following June.

3) Does every child need to submit documentation of a lead test with results?
Only students in NYC Day Care are required to submit documentation for a lead test. It is no longer required for preschoolers. It is however still recommended as lead poisoning can lead to serious health problems.

4) Can international students submit medical records from another country?
Yes, however a translation is requested if the records are not in English. Please be advised that not all countries have the same requirements, so you may need to provide additional information.

5) My child’s immunization records are incomplete.
Immunization schedules are very specific as noted by the NYS Department of Health. If your child’s immunization records are incomplete, have your pediatrician submit a signed note stating when the remaining immunizations are scheduled. If there is a medical reason why immunizations are not complete, we need a letter from your physician explaining the situation. If there is a religious reason why immunizations are not submitted, a signed letter from the parents stating your beliefs is required. Medical and religious exemption forms are available upon request.

6) Please explain vision, hearing & dental screenings.
Children are not required to see a vision, hearing specialist, or dentist to fulfill NYC requirements. If your pediatrician addresses vision, hearing, and dental on the main form with something simple such as “seems fine for age” or “grossly normal”, that is sufficient. If your child goes to the dentist or sees a specialist, a note from the doctor/dentist with the date of the visit is requested; we will add this to your child’s medical records.

7) What do I do if my child has food allergies?
Please alert your teachers about any food allergies or dietary restrictions your child may have. If your child has a serious allergy that requires an Epi-Pen or medical intervention, please request the “Written Medical Consent Form,” which must be filled out and signed by both the parents and physician.

8) Are flu shots now required?
Yes, the NYC Department of Health now requires annual flu shots. Flu shots must be administered between July and December each school year.

9) Do we need to use the blank health form IPS provides?
As long as we get all the required information, any form can be used. Many NYC pediatricians prefer to use their own forms.

10) Where do I send the completed forms?
You can email or fax your information to:
West 76th Street:, 212.724.1654
East 86th Street:, 212.988.2139

You may also hand-deliver them at your IPS location. However, you do not need to send us the original hard copies of the forms. We recommend that you keep those for your records.

NYC Department of Health and Mental Hygiene Medical Requirements for School Entrants

All students entering a New York City School must provide a complete physical examination and all required immunizations:

1). Physical examinations and screenings. All children shall receive a complete, age-appropriate medical examination, including but not limited to:

  • physical exam,
  • development assessment and history,
  • nutrition/allergy assessment,
  • and if indicated, screening tests for dental, vision, and hearing.

NOTE: All forms need to be SIGNED and DATED by your physician and submitted to IPS.

2) RECORDS. IPS will maintain medical records for all children and staff.

3) PERIODIC EXAMINATIONS. Children up to the age of 2 years are required to have a physical exam every 6 months. At 2 years and older, an annual exam is required.

**In accordance with same Public Health Law, exemptions from specific immunizations may be permitted for medical contra-indications or on religious grounds.

4) IMMUNIZATION RECORDS. According to NYC Public Health law 2164, all children shall be immunized.** The following immunization requirements are mandated by law. Children must be excluded from school if they do not meet these requirements:

Immunization No. OF DOSES
DTap (diphtheria-tetanus-acellular pertussis) OR
DTP (diphtheria-tetanus-pertussis)
Fourth dose at least 6 months after the third.
IPV (inactivated poliovirus) 3
MMR (measles-mumps-rubella)
On or after the 1st birthday.
HIB (Haemophilus influenzae type b)
Hepatitis B 3
On or after 1st birthday.
PCV (Pneumococcal conjugate)
Number of doses based on age when first given.
Flu Shot
Annually administered between July and December.

New students may enter school with partial immunizations while completing the remaining vaccinations on the specific schedule mandated by the NYC/NYS Department of Health.