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.)

    Guidelines for the Provision of Health Services and/or Section 504 Accommodations for Students for the 2013-2014 School Year   
    This document is also available in Arabic | BengaliChinese (simplified) | Chinese (traditional)FrenchHaitian Creole | Korean  | RussianSpanish | Urdu 
     
    1) Medication Administration Form (MAF) including Parent/Guardian's Consent, Authorization and Release for the School-Year 2013-2014 
    This form is also available in Arabic | Bengali | Chinese (simplified)  | Chinese (traditional) | FrenchHaitian Creole | Korean | Russian | Spanish | Urdu

    2) Request for Provision of Medically Prescribed Treatment(Non-Medication) Form 2013-2014  
    Arabic  | Bengali | Chinese (simplified) | Chinese (traditional) | French | Haitian Creole | Korean | Russian | Spanish | Urdu

    3)  School Diabetes Management Form including Parent/ Guardian's Consent, Authorization and Release 2013-2014 
    This form is also available in   Arabic | Bengali |  Chinese (simplified) | Chinese (traditional)French | Haitian Creole | Korean | Russian | Spanish | Urdu

    4) Request for Accommodations Under Section 504 of the Rehabilitation Act of 1973 for 2013-2014 
    This form is also available in Arabic | BengaliChinese (simplified) | Chinese (traditional)French | Haitian Creole  | Korean | Russian | Spanish | Urdu

    504 Accommodation Plan

    Parent Letter -- Renewal 

    This letter is also available in Arabic | Bengali | Chinese (simplified) | Chinese (traditional)| French | Haitian Creole | Korean | Russian | Spanish | Urdu

    Parent Letter -- new students
    This letter is also available in Arabic | Bengali | ChineseFrench | 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)