Forms + Checklist
Child and Adolescent Health and Examination Form
The Child and Adolescent Health and Examination Form is to be completed by your child’s NYS medical practitioner. It is required for school entry for the following students:
As soon as your child has their next annual well-visit, please upload a copy to the August Schools Health portal. All preschool students are required to receive a yearly flu vaccine by December 15.
Annual Over-the-Counter (OTC) Medication Form
OTC Medication Form to be completed and signed by both parent/guardian and pediatrician.
Action Plans for Students with Severe Allergies/Anaphylaxis, Asthma, Seizures, or Diabetes
If your child may require medication during school for severe allergic reaction/anaphylaxis, asthma, seizures, or diabetes, your pediatrician must complete an action plan.
Anaphylaxis/Allergy action plan for students with severe allergies/anaphylaxis
Asthma action plan for students requiring an inhaler in school
Seizure action plan for students with rescue meds
For Diabetes forms, please contact nurses@saintannsny.org or your child’s endocrinologist.