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CHILD & ADOLESCENT HEALTH EXAMINATION FORM. Please Print. Clearly . NYC ID (OSIS) TO BE COMPLETED BY THE PARENT OR GUARDIAN. Child’s Last Name. First Name
CH205 Health Exam 5 08 Rev. CHILD & ADOLESCENT HEALTH EXAMINATION FORM Please. Print Clearly. NYC DEPARTMENT OF HEALTH & MENTAL HYGIENE — DEPARTMENT OF EDUCATION Press Hard. STUDENT ID NUMBER OSIS. TO BE COMPLETED BY PARENT OR GUARDIAN. Child’s Last Name First Name Middle Name.
If your child’s school has a school-based health center, your child can also receive a physical exam at school. Make sure to bring a copy of the new admission exam form (CH-205) with you to the visit. As a last option, an Office of School Health doctor can also give your child a physical exam at your child’s school.
Bring the physical examination form (CH-205) to the visit. All students entering New York City public or private schools or child care (including universal pre-K classes) for the first time should submit the physical examination form by May 31, 2019.
All students entering NYC public or private schools or child care (including Universal 3-K and Pre-Kindergarten classes) for the first time must submit a report of a physical examination performed within one year of school entry.
HISTORY FORM | Preparticipation Physical Evaluation. (Note: This form is to be filled out by the patient and parent prior to seeing the medical provider. The medical provider should keep this form in the student’s medical file. This form does not get returned to the athletic department.)
All students entering a New York City school, including public/private/parochial schools or day care centers, for the first time must have a complete physical examination and all required immunizations documented on a Child Adolescent Health Examination Form (CH205). (New York City Health Code Article 47.25 Health, child admission criteria.)
