FAQs

Health Appraisals

Question: If a student has not submitted a health apprasial, can the school's medical director do a physical without parental permission?

Answer: Information in the Commissioner's Regulation 136.3 provides this framework for obtaining mandated physicals:

Schools have 30 days from the date of school entry in Pre-K or K and in Grades 2,4,7 and 10 or upon initial entry to the school to obtains a copy of a health certificate from the parent/guardian of the student

If after 30 days one is not provided, a written notification (ideally sent by certified mail to ensure receipt) is sent to the parent/guardian informing them that the schools's meical director will perform a health appraisal in 30 days if one is not provided by the parent/guardian to the school.

If a parent/guardian refuses to allow the student to be examined by the medical director, the school administrator should consult with the school district's attorney before enforcing any existing board of education policies.

Prental permission prior to examination is strongly encouraged.

Question: Health Appraisals (physicals) are required for new enterers to school. How do you decide if your new enterers are the Pre-Kindergarten or Kindergarten students?

Answer: You need to ask your school's registrar if the Pre- Kindergarten (Pre-K) students were officially registered for the district as new students and given their student identification number that will be used for their tenure in the district, or if your students are officially entering school in the Kindergarten year.
Physicals are required at Pre-K or Kindergarten. If your Pre-Kindergarten students are your new enterers, they require a physical. If these student had a physical for Pre-K, they do not require one for Kindergarten.
The Commissioner's Regulations in Section 136.3 state:

Each student enrolled in the public school to have a satisfactory health examination conducted by the student's family physician, physician assistant or nurse practitioner, upon the student's entrance in such school at any grade level and for each student entering pre- kindergarten or kindergarten and in the 2nd, 4th, 7th and 10th grades.

Question: What is the period of time that a sports physical is valid for?

Answer: A sports physical is valid for a period of 12 months through the last day of the month in which the physical was conducted. The physical is valid for the entire sports season.

Question: What is the guidance regarding re-certification prior to each sports season?

Answer: Please be aware of your own district's procedure for sports clearance. Prior to each sports season school nurses should either have the parent complete an interval health history or interview the student to update the health history. This process should be done within 30 days of the start of tryout practice sessions. If the student had a full medical examination within the immediately preceding 30 calendar days, this interval health history does not have to be done.

Question: When should we be sending out dental certificates?

Answer: As you send out notice of the requirement of a mandated health appraisal, or physical, you should "request" that a dental certificate be provided to the school. Whenever you require a health appraisal, you should request a dental certificate.

The recommended form can be found at:

http://www.emsc.nysed.gov/sss/documents/amendedDentalHealthCert829082.doc

Question: Do any of the available growth charts note the 99th percentile when looking at student weight status category?

Answer: The New York State Department of Health now has growth charts that note the 99th percentile.
You may order these charts at the following website:
http://www.nyhealth.gov/prevention/obesity/bmi_screening_tools.htm

Question: What should the school nurse do when this year's health appraisals (physicals) do not have the BMI percentile or Weight Status Category (WSC) completed on the form sent to the school by the private provider?

Answer: There are several strategies that the nurse could consider:

If the health certificate is incomplete, it would be advisable for the school nurse to return a copy of the form to the family for completion by the family’s private healthcare provider (from the NYS Department of Health Frequently Asked Questions).

The nurse can ask the private provider if the form could be faxed to them for completion. The school nurse should not write on a health certificate from a private provider.

Your medical director could request that nurses do the heights, weights, and BMIs and then the nurse could provide them with a “Body Mass Index-for-Age Percentile Chart” to figure the WSC.

Your medical director could request that you go to the Online Calculator form the CDC http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx and input the student’s information, print it out, and provide them with that information.

Your medical director could assign WSC to those physicals done by private providers with missing information and attach a signed addedendum to each health appraisal. The medical director must sign each Weight Status Category determination for the purposes of the statewide survey.

Information can be noted as missing at the time of the survey.

Question: For what period of time is a physical valid?

Answer: The Commissioner's Regulations (found at the top of the Laws and Guidelines page) state the following in Section 136.3 b (1):

It shall be the duty of the trustees and boards of education to require each student enrolled in the public school to have a satisfactory health examination conducted by the student's family physician, physician assistant or nurse practitioner, upon the student's entrance in such school at any grade level and for each student entering pre-kindergarten or kindergarten and in the 2nd, 4th, 7th and 10th grades. Such examination shall be acceptable for purposes of this section if it is administered not more than twelve months prior to the commencement of the school year in which the examination is required.

If your school year began on September 3, 2008, then any physical conducted on September 3, 2007 or later is valid for the entire 2008 - 2009 school year.

Question: Do schools need to request dental certificates to accompany the Health Certificates (physicals)?

Answer:

Students entering the district who are required to have health certificates will need to produce a dental certificate if they have one. Students will be permitted to attend school regardless of whether or not they have a dental certificate.

A list of dentists who are willing to screen students for the dental certificate for a reduced fee is available on the laws and Guidelines page, under Dental Certificates.

When(physicals) are required in the mandated years – dental certificates are requested. If the dental certificate is received, it should be filed in the cumulative health record.

Question: Is there a way to "customize" the recommended Health Appraisal Form?

Answer: There is now a document on our website titled, "Health Appraisal - Recommended - Customizable" on the Laws & Guidelines page under HEALTH APPRAISALS. We recommend maintaining the integrity of this form and at the same time customize it to include your school's information.

Question: Can a school nurse accept a physical done by a physician from a foreign country for a foreign exchange student?

Answer: No. The Commissioner's Regulations state: "The health certificate shall be signed by a duly licensed physician, physician assistant, or nurse practitioner, who is:
(1) authorized by law to practice in this State, and consistent with any applicable written practice agreement; or
(2) authorized to practice in the jurisdiction in which the examination was given, provided that the commissioner has determined that such jurisdiction has standards of licensure and practice comparable to those of New York."

A jurisdiction with standards and licensure comparable to New York is considered to be any provider licensed in the United States, so all physicals must be performed by physicians, nurse practitioners or physician's assistants licensed in the United States.

Question: What are the grade level requirements for mandated health appraisals?

Answer: Health appraisals are required for new entrants, PreK or Kindergarten, Grades 2, 4, 7 and 10.
(Commissioner’s Regulations, 9/25/05)

Question: Are heights and weights done annually or on the years with health appraisals?

Answer: The minimum requirements for heights and weights are that they should be done on the years that students have their health appraisals completed. Childhood obesity is currently a major health issue and some districts are choosing to do a height and weight (some add a Body Mass Index reading as well) on an annual basis to monitor student growth. A decision regarding heights and weights should be made on a district level to standardize practice in the district’s health offices.

Question: Does the revised Article 19 allow school health professionals to accept a physical exam from an out of state MD/NP?

Answer: YES. Effective September 2005, you MAY accept a physical exam that was conducted by a duly licensed Physician, Physician Assistant, Or Nurse Practitioner, who is authorized to practice in the jurisdiction in which the examination was given, provided that the commissioner has determined that such jurisdiction has standards of licensure and practice comparable to those of New York.