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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.) 

504 FAQs
 
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    Guidelines for the Provision of Health Services and/or Section 504 Accommodations for Students for the 2016-2017 School Year     
        
    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو

    1) Asthma Medication Administration Form (AMAF) including Parent/Guardian's Consent, Authorization and Release for the School-Year 2016-2017 

    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو

    2) Allergies/Anaphylaxis Medication Administration Form (AAMAF) including Parent/Guardian's Consent, Authorization and Release for the School-Year 2016-2017 

    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو

    3) Medication Administration Form (MAF) including Parent/Guardian's Consent, Authorization and Release for the School-Year 2016-2017 

    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو

    4) Request for Provision of Medically Prescribed Treatment (Non-Medication) Form 2016-2017  

    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو

    5)  School Diabetes Medication Administration Form (DMAF) including Parent/ Guardian's Consent, Authorization and Release 2016-2017 

    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو

    6) Request for Section 504 Accommodations with HIPAA Authorization 2016-2017  - NEW - Request form is now 2 parts - this form is to be completed by Parents

    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو

    7) Medical Review for 504 Accommodations 2016-2017 - NEW - Request form is now 2 parts - this form is to be completed by a Medical Practitioner


    Instructions for the Use of the HIPAA-compliant Authorization Form

    Authorization for Release of Health Information Pursuant to HIPAA

    504 Accommodation Plan

    Parent Letter -- Renewal 

    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو

    Parent Letter -- new students

    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو


    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

    Policy Statement 

    العربية   | বাংলা   | 中文   | Français   | Kreyòl Ayisyen   |  한국어   | Русский  |  Españolاردو

    Notice of Non-Discrimination Under Section 504

    Educational Advocates