[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-194455-105":53,"doc-detail-194455-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","nys-school-health-examination-form-to-be-completed-by-private-healthcare-provider-or-school-medical-director","NYS School Health Examination Form - To Be Completed by Private Healthcare Provider or School Medical Director","","NYS School Health Examination Form用于新入学及特定年级学生的体检信息记录，要求由私营医疗机构提供方或学校医疗主任完成，必要时标注未评估项目。表单包含学生基本信息、健康史（过敏、哮喘、癫痫、糖尿病等及相关随附计划）、体格检查与评估、实验室检测与风险筛查，以及视力/听力与脊柱侧弯等筛查结果。另设体育教育与运动参与评估、家族心脏史核对、限制参与类型与其他配套安排，并预留附加信息与处方/计划文件上传记录。",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/nys-school-health-examination-form-to-be-completed-by-private-healthcare-provider-or-school-medical-director/194455/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/nys-school-health-examination-form-to-be-completed-by-private-healthcare-provider-or-school-medical-director/194455.png","ImageObject",442,249,{"name":88,"@type":89},"Maeve","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-07","2026-09-03",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"哪些人需要完成这份NYS学校健康体检表？","Question",{"text":109,"@type":110},"私营医疗服务提供方或学校医疗主任需完成。若某些项目未进行评估，应在表内标注“Not Done”。","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"健康史部分需要填写哪些常见诊断与相关文件？",{"text":114,"@type":110},"包括过敏、哮喘、癫痫、糖尿病等。若勾选“Medication/Treatment Order Attached”或护理计划相关选项，应填写并附上相应订单或计划（如Anaphylaxis Care Plan、Asthma Care Plan、Seizure Care Plan、Diabetes Medical Management Plan）。",{"name":116,"@type":107,"acceptedAnswer":117},"表单如何评估学生参与体育教育或运动的资格？",{"text":118,"@type":110},"需核对家庭心脏史（体育要求），并勾选学生是否可在无限制情况下参与全部活动；如有限制，需说明限制参与的运动类型与其他需要的配套安排，并在必要时使用附加空间说明。","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},194455,1788439240,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":126,"read_time":9},5909877438554,"https://ap-avatar.wpscdn.com/avatar/5600025385ad2bf12a7?_k=1778553567797529272","| REQUIRED NYS SCHOOL HEALTH EXAMINATION FORM TO BE COMPLETED BY PRIVATE HEALTHCARE PROVIDER OR SCHOOL MEDICAL DIRECTOR IF AN AREA IS NOT ASSESSED, INDICATE NOT DONE |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Note: NYSED requires a physical exam for new entrants and students in Grades Pre-K or K, 1, 3, 5, 7, 9 & 11; annually for interscholastic sports; and working papers as needed; or as required by the Committee on Special Education (CSE)\u003Cbr>or Committee on Pre-School Special Education (CPSE) . |  |  |  |  |  |  |  |  |  |  |  |  |\n| STUDENT INFORMATION |  |  |  |  |  |  |  |  |  |  |  |  |\n| Name: |  |  |  |  | Affirmed Name (if applicable): |  |  |  |  |  |  | DOB: |\n| Sex Assigned at Birth: ☐ Female ☐ Male |  |  |  |  | Gender Identity: ☐ Female ☐ Male ☐ Nonbinary ☐ X |  |  |  |  |  |  |  |\n| School: |  |  |  |  |  |  |  |  |  | Grade: |  | Exam Date: |\n| HEALTH HISTORY |  |  |  |  |  |  |  |  |  |  |  |  |\n| If yes to any diagnoses below, check all that apply and provide additional information. |  |  |  |  |  |  |  |  |  |  |  |  |\n| ☐ Allergies |  | Type: |  |  |  |  |  |  |  |  |  |  |\n|  |  | ☐ Medication/Treatment Order Attached |  |  |  |  |  |  | ☐ Anaphylaxis Care Plan Attached |  |  |  |\n| ☐ Asthma |  | Type: ☐ Intermittent ☐ Persistent ☐ Other: |  |  |  |  |  |  |  |  |  |  |\n|  |  | ☐ Medication/Treatment Order Attached |  |  |  |  |  |  | ☐ Asthma Care Plan Attached |  |  |  |\n| ☐ Seizures |  | Type: |  |  |  |  |  |  | ☐ Date of Last Seizure: |  |  |  |\n|  |  | ☐ Medication/Treatment Order Attached |  |  |  |  |  |  | ☐ Seizure Care Plan Attached |  |  |  |\n| ☐ Diabetes |  | Type: ☐ 1 Type: ☐ 2 |  |  |  |  |  |  |  |  |  |  |\n|  |  | ☐ Medication/Treatment Ordered Attached |  |  |  |  |  |  | ☐ Diabetes Medical Management Plan Attached |  |  |  |\n| Risk Factors for Diabetes or Pre-Diabetes: Consider screening for T2DM if BMI % > 85% and has 2 or more risk factors: Family History T2DM, Ethnicity, Sx Insulin Resistance, Gestational Hx of Mother, and/or pre-diabetes. |  |  |  |  |  |  |  |  |  |  |  |  |\n| BMI  kg/m2\u003Cbr>Percentile (Weight Status Category) ☐ \u003C5th ☐ 5th-49th ☐ 50th-84th ☐ 85th-94th ☐ 95th-98th ☐ 99th and > |  |  |  |  |  |  |  |  |  |  |  |  |\n| Hyperlipidemia: ☐ Yes ☐ No ☐ Not Done |  |  |  |  |  |  | Hypertension: ☐ Yes ☐ Not Done |  |  |  |  |  |\n| PHYSICAL EXAMINATION/ASSESSMENT |  |  |  |  |  |  |  |  |  |  |  |  |\n| Height: Weight: BP: Pulse: Respirations: |  |  |  |  |  |  |  |  |  |  |  |  |\n| Laboratory Testing |  | Positive | Negative | Date |  | Lead Level\u003Cbr>Required for PreK & K |  |  |  |  |  | Date |\n| TB-PRN |  | ☐ | ☐ |  |  | ☐ Test Done ☐ Lead Elevated ≥ 5 µg/dL |  |  |  |  |  |  |\n| Sickle Cell Screen-PRN |  | ☐ | ☐ |  |  |  |  |  |  |  |  |  |\n| ☐ System Review Within Normal Limits\u003Cbr>☐ Abnormal Findings–List Other Pertinent Medical Concerns Below (e.g., concussion, mental health, one functioning organ) |  |  |  |  |  |  |  |  |  |  |  |  |\n| ☐ HEENT\u003Cbr>☐ Dental\u003Cbr>☐ Mental Health | ☐ Lymph nodes\u003Cbr>☐ Cardiovascular\u003Cbr>☐ Lungs |  |  | ☐ Abdomen\u003Cbr>☐ Back/Spine/Neck\u003Cbr>☐ Genitourinary |  |  |  | ☐ Extremities\u003Cbr>☐ Skin\u003Cbr>☐ Neurological |  |  | ☐ Speech\u003Cbr>☐ Social Emotional ☐ Musculoskeletal |  |\n| ☐ Assessment/Abnormalities Noted/Recommendations: |  |  |  |  |  |  |  | Diagnoses/Problems (list): ICD-10 Code*\u003Cbr>*Required only for students with an IEP receiving Medicaid |  |  |  |  |\n| ☐ Additional Information Attached |  |  |  |  |  |  |  |  |  |  |  |  |\n\n\n| Name: |  |  |  |  | Affirmed Name (if applicable): |  |  |  |  |  | DOB: |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| SCREENINGS |  |  |  |  |  |  |  |  |  |  |  |\n| Vision & Hearing Screenings Required for New Entrants, PreK or K, 1, 3, 5, 7, & 11 |  |  |  |  |  |  |  |  |  |  |  |\n| Vision | With Correction ☐ Yes ☐ No |  |  | Right |  |  |  | Left |  | Referral | Not Done |\n| Distance Acuity |  |  |  | 20/ |  |  ","cbCaiqnpVoE4hlei","https://ap.wps.com/l/cbCaiqnpVoE4hlei","pdf",254295,"English","# Student Information\n# Health History\n# Physical Examination/Assessment\n# Screenings\n# Participation in Physical Education/Sports/Playground/Work\n# Medications","[{\"question\":\"哪些人需要完成这份NYS学校健康体检表？\",\"answer\":\"私营医疗服务提供方或学校医疗主任需完成。若某些项目未进行评估，应在表内标注“Not Done”。\"},{\"question\":\"健康史部分需要填写哪些常见诊断与相关文件？\",\"answer\":\"包括过敏、哮喘、癫痫、糖尿病等。若勾选“Medication/Treatment Order Attached”或护理计划相关选项，应填写并附上相应订单或计划（如Anaphylaxis Care Plan、Asthma Care Plan、Seizure Care Plan、Diabetes Medical Management Plan）。\"},{\"question\":\"表单如何评估学生参与体育教育或运动的资格？\",\"answer\":\"需核对家庭心脏史（体育要求），并勾选学生是否可在无限制情况下参与全部活动；如有限制，需说明限制参与的运动类型与其他需要的配套安排，并在必要时使用附加空间说明。\"}]","NYS School Health Examination Form - To Be Completed by Private Healthcare Provider or School Medical Director | PDF"]