School Health Forms

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.) Please note translations for the 2012-13 forms below will be posted as soon as they are available.

Educational Advocates (English)

About Us Academics Choices & Enrollment Schools in the Community Offices & Programs Office of School Health Rules & Policies Student Support, Safety & Activities Performance & Accountability	School Health Forms 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.) *Please note translations for the 2012-13 forms below will be posted as soon as they are available.* Guidelines for the Provision of Health Services and/or Section 504 Accommodations for Students for the 2012-2013 School Year This document is also available in Arabic \| Bengali \| Chinese \| French \| Haitian Creole \| Korean \| Russian \| Spanish \| Urdu 1) Medication Administration Form (MAF) including Parent/Guardian's Consent, Authorization and Release for the School-Year 2012-2013 This form is also available in Arabic \| Bengali \| Chinese \| French \| Haitian Creole \| Korean \| Russian \| Spanish \| Urdu 2) Request for Provision of Medically Prescribed Treatment(Non-Medication) Form 2012-2013 This form is also available in Arabic \| Bengali \| Chinese \| French \| Haitian Creole \| Korean \| Russian \| Spanish \| Urdu 3) School Diabetes Management Form including Parent/ Guardian's Consent, Authorization and Release 2012-2013 This form is also available in Arabic \| Bengali \| Chinese \| French \| Haitian Creole \| Korean \| Russian \| Spanish \| Urdu 4) Request for Accommodations Under Section 504 of the Rehabilitation Act of 1973 for 2012-2013 This form is also available in Arabic \| Bengali \| Chinese \| French \| Haitian Creole \| Korean \| Russian \| Spanish \| Urdu 504 Accommodation Plan Parent Letter -- Renewal This letter is also available in Arabic \| Bengali \| Chinese \| French \| Haitian Creole \| Korean \| Russian \| Spanish \| Urdu Parent Letter -- new students This letter is also available in Arabic \| Bengali \| Chinese \| French \| Haitian Creole \| Korean \| Russian \| Spanish \| Urdu Notice of Eligibility Determination Allergy Response Plan Medical Review of Student with Severe Allergies Standing Order for Administration of Epinephrine for Nurses Training Program for Unlicensed School Personnel to Administer Epinephrine DOHMH Regional Offices Policy Statement This statement is also available in Arabic \| Bengali \| Chinese \| French \| Haitian Creole \| Korean \| Russian \| Spanish \| Urdu Notice of Non-Discrimination Under Section 504 Educational Advocates (English)