This form is to be completed by a physician,
nurse practitioner or physician assistant.
Medical Certificate of Physical
Limitations
Should a student be temporarily or permanently unable to
participate in the regular program
of physical education, a program must be developed to meet
the needs of
that student. A certified adaptive physical education
teacher is on staff.
Authorization to Use
Medications/Receive Treatments at School
Written authorization from a medical provider is required
for any medication that is to be given in school.
This form is to be completed by a physician,
nurse practitioner or physician assistant.
Dental
Certificate
New York State requires districts to request a dental health
certificate from parents as part of the general health
assessment (Chapter 281 of the Laws of 2007) for children
entering grades 2, 4, 7 and 10.
