ࡱ> 574c 6bjbj 4MbMb6 rrrrr$n""""""""$@'"r"rr(" rr h"Vm@1 zz#" >"0n"x'd'1 'r1 d""?dn"'B 8: Sample: Parent Notification/Request For Mandated Health Appraisal Dear Parent(s) or Guardian(s): New York State law requires that each child in a school district have a health examination including body mass index before entering school for the first time, and again in grades 1, 3, 5, 7, 9, 11. Students wishing to play interscholastic sports or requesting work permits must have an annual health exam. A dental exam form is also requested, but not required at these same times. Your own health care provider is always the best choice for these exams. We encourage you to call early as it may take several weeks to schedule exams during the busy summer and fall months. We have included a form for your health provider to complete. We can accept any exam form dated before _____________. You or your provider may return the completed form to the school health office. If you do not provide an exam form by _____________, an exam will be scheduled with our school medical director. While most parents choose not to attend, you may do so if you wish. Please let your child know they will be examined at school. Upon completion of in-school exams, you will be informed of any important findings and need to follow up with your health care provider. Please Complete And Return The Bottom Portion To Your Building Health Office Today ...(.. Students Name ________________________________ Grade ____________ Students School _____________________________________ My child had a health exam on ________. I will return the completed form by the date above. My child has an appointment to have a physical with his/her health care provider on _________. My childs MD/NP/PA or I will return the form by the date above. I need information on obtaining health insurance or finding a health care provider. Schedule the district physician/nurse practitioner to complete the exam for my child. Parent Name _________________________________________________ Date ___________ Parents Signature _____________________________________________ Parent Phone Contact ( ) ________________________ This sample document is available on the NYS Center for School Health Website @  HYPERLINK "http://www.schoolhealthny.com" www.schoolhealthny.com (1/10/20) (19ABCD     ! # $ & ' * U [ \ ^  G uffffh>$hf4CJOJQJ^Jh>$h5;CJOJQJ^Jh>$h CJOJQJ^Jh>$hLCJOJQJ^Jh>$hmaCJOJQJ^Jh>$h1CJOJQJ^Jh>$hoKCJOJQJ^Jh>$hoK5CJOJQJ^Jh>$h4#5CJOJQJ^Jh>$h15CJOJQJ^J"BCDcd m n ` a D uv & FLh]L^hgd1 & Fh^hgd1gd1$a$gd1G M S e       l m s a C S \ b ◈ӗyjjjh>$hLpCJOJQJ^Jh>$h4#CJOJQJ^Jh>$hmaCJOJQJ^Jh>$hoKCJOJQJ^Jh>$h5;CJOJQJ^Jh1h1CJOJQJ^Jh>$hLCJOJQJ^Jh>$hf4CJOJQJ^Jh>$h1CJOJQJ^Jh>$hrCJOJQJ^J"b c o y !=?AKRSat|j[L[==h>$hAJTCJOJQJ^Jh>$hrCJOJQJ^Jh>$h^sYCJOJQJ^J#h>$h15CJOJQJ^JaJ h>$hoKCJOJQJ^JaJ h>$h1CJOJQJ^JaJ h>$hrCJOJQJ^JaJ#h>$hoK5CJOJQJ^JaJh>$hoKCJOJQJ^Jh>$h1CJOJQJ^Jh>$hLpCJOJQJ^J" j"h>$hLpCJOJQJ^Jtuv)*KOy 7CU*+6⦚⦚xxgx h>$h10JCJOJQJ^J%jh>$h1CJOJQJU^Jh>$h4#CJOJQJ^Jh1CJOJQJ^Jh1h1CJOJQJ^Jh>$hrCJOJQJ^Jh>$h^sYCJOJQJ^Jh>$hAJTCJOJQJ^Jh>$h1CJOJQJ^Jh>$hoKCJOJQJ^J'lV6 $xxa$gd1xxgd1 & Fh^hgd1gd1h^hgd1 21h:p1/ =!F"#$h% s2&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH H`H oKNormal CJOJQJ_HaJmH sH tH DA`D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 6U@6 1 Hyperlink >*B*phcHH r Balloon TextCJOJQJ^JaJN/N rBalloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< 6 .G b t6 6  * 6 X8@0(  B S  ?8 8 33^e5 8 ^e5 8 8Л\z-G;lڲyK$~hh^h`>*OJQJo(whhHh8^8`OJQJ^Jo(hHoh^`OJQJo(hHh ^ `OJQJo(hHh ^ `OJQJ^Jo(hHohx^x`OJQJo(hHhH^H`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohp^p`OJQJo(hHh@ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohp^p`OJQJo(hHh@ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohP^P`OJQJo(hHyK$8-G;        F`O        F`O        L '">$f4oKAJTX^sYLp=qr5;maSFb14#6 8 __Grammarly_42____i__Grammarly_42___14H4sIAAAAAAAEAKtWckksSQxILCpxzi/NK1GyMqwFAAEhoTITAAAAPH4sIAAAAAAAEAKtWcslP9kxRslIyNDa0NLUAQnNjAwMLY3NjSyUdpeDU4uLM/DyQAqNaALNK5OYsAAAA@6 p@Unknown G*Cx Times New Roman5Symbol3.*Cx Arial7.*@Calibri;Wingdings5..[`)Tahoma9. . Segoe UI?= .Cx Courier NewA$BCambria Math"h/KK U__!F242 2  3QHP ?oK2!xxq (Health Appraisal Letter to parents CindyBOCES2 Linda Khalil   Oh+'0 4@ ` l x ,Health Appraisal Letter to parents CindyBOCES2 Normal.dotmLinda Khalil12Microsoft Office Word@> @!@:y@#_ ՜.+,D՜.+,h$ hp  Monroe 2-Orleans BOCES2  )Health Appraisal Letter to parents Cindy Title 8@ _PID_HLINKSAx&"http://www.schoolhealthny.com/  !"#%&'()*+-./01236Root Entry F`P#81Table'WordDocument4SummaryInformation($DocumentSummaryInformation8,CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q