Health Services Forms

New York State School Health Examination Form

health-exam-form 20-21.pdf 235.31 KB (Last Modified on June 4, 2020)

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Dental Certificate

Dental Cert 829082.doc 204.5 KB (Last Modified on August 16, 2017)

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Parent Consent For Health Exam

Parent informed consent health exam. 2013-2014.doc 203.00 KB (Last Modified on August 28, 2013)

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Parent Permission to Administer Medication In School

Parent Permission to Administer Medication.docx 61.86 KB (Last Modified on August 22, 2018)

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Prescribers Authorization for Medication Administration

Meds MD order Independent UseCarry Attestation Form.doc 127.5 KB (Last Modified on August 22, 2018)

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Field & Walking Trip Medical Consent (RA Eng/Sp)

Field Walking Trip Medical Consent RA EngSp.pdf 119.44 KB (Last Modified on August 28, 2013)

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RCSD Physician Request for Special Dietary Accommodations

RCSD Physicians request for Special Dietray Acommodations.docx 83.03 KB (Last Modified on August 28, 2014)

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Physician Request for Special Dietary Accommodations Spanish

RCSD Spanish Physicians request for Special Dietray Acommodations Span.docx 47.51 KB (Last Modified on August 28, 2014)

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Release of Medical Information (English)

RCSD HIPAA English.pdf 21.53 KB (Last Modified on February 5, 2013)

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Release of Medical Information (Spanish)

RCSD HIPAA Spanish.pdf 24.77 KB (Last Modified on February 5, 2013)

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The Rochester City School District does not discriminate on the basis of an individual's actual or perceived race, color, religion, creed, ethnicity, national origin, citizenship status, age, marital status, partnership status, disability, predisposing genetic characteristics, sexual orientation, gender (sex), military status, veteran status, domestic violence victim status or political affiliation, and additionally does not discriminate against students on the basis of weight, gender identity, gender expression, and religious practices or any other basis prohibited by New York State and/or federal non-discrimination laws in employment or its programs and activities. The District provides equal access to community and youth organizations. NYS CR Part #154 requires the District to provide communications to ELL families in the home language that they best understand. In order to request interpretation or translation services, employees may visit www.rcsdk12.org/translationservices. For emergencies or immediate communication needs, please use the Language Line at 1-866-874-3972. School secretaries in each school or program can provide the access code for this service.

Student Health Services

Health Services Forms