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State of Connecticut Department of Education Early …

WEBPart II — Medical Evaluation ED 191 REV. 8/2011 Health Care Provider must complete and sign the medical evaluation, physical examination and immunization record. Child’s Name

Actived: 6 days ago

URL: https://secure.infosnap.com/resources/1509/files/15-16Early_Childhood_Health_Assessment_Record_1%20(1).pdf

Health Assessment Record

WEBAn immunization update and additional health assessments are required in the 6th or 7th grade and in the 9th or 10th grade. Specific grade level will be determined by the local …

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State of Connecticut Department of Education Health …

WEBPart 1 — To be completed by parent/guardian. Please answer these health history questions about your child before the physical examination. Please circle Y if “yes” or N …

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Maryland Schools Physical Examination To Parents or Guardians

WEB2023 – 2024 PART I – HEALTH ASSESSMENT To be completed by parent or guardian . Student’s Name (Last, First, Middle) Birthdate (Mo. Day Yr.) Gender (M/F) Name of …

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2016-17 School Year New York State Immunization …

WEBVaccines Prekindergarten (Day Care, Head Start, Nursery or Pre-k) Kindergarten and Grades 1 and 2 Grades 3, 4 and 5 Grades 6, 7 and 8 Grades 9, 10, 11

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KINDERGARTEN / NEW ENTRANT DENTAL FORM

WEBKINDERGARTEN / NEW ENTRANT DENTAL FORM. Dear Parent: “Prevention of dental disease is less costly than neglect.”. Now is the time to make arrangement for your …

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NORTH CAROLINA HEALTH ASSESSMENT TRANSMITTAL FORM

WEBJanuary 2016 . Hearing screening information: Passed hearing screening: Yes No Concerns related to student’s hearing: Recommendations, concerns, or needs related to student’s …

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Child Health Report

WEBDivision of Early Care and Education DCF-F-CFS0060-E (R. 07/2013) CHILD HEALTH REPORT – CHILD CARE CENTERS. Use of form: Use of this form is voluntary; …

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State of Illinois Certificate of Child Health Examination

WEBTitle: Child Health Examination Form - November 2015 Author: DHSHPAG Keywords: immunization, form, health, exam, examination, school, 11/15 Created Date

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State of Illinois Certificate of Child Health Examination

WEBStudent’s NameLast Birth Date Sex School Grade Level/ ID First Middle Month/Day/ Year # HEALTH HISTORY TO BE COMPLETED AND SIGNED BY PARENT/GUARDIAN AND …

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Dental Health Certificate

WEBDental Health Certificate Parent/Guardian: New York State law (Chapter 281) permits schools to request a dental examination in the following grades: school entry,

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WEST CONTRA COSTA UNIFIED SCHOOL DISTRICT

WEBPupil Services Center 2465 Dolan Way, San Pablo, CA 94806 (510) 307-4646 FAX (510) 741-8971. Matthew Duffy Superintendent of Schools. Dear Parent or Guardian: Steve …

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Oral Health Assessment/Waiver Request Form

WEBSection 3: Waiver of Oral Health Assessment Requirement To be filled out by parent or guardian asking to be excused from this requirement I request that my child be excused …

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SCHOOL HEALTH SERVICES PROGRAM

WEBversion 3.7.2023 3 899 North Capitol Street NE, 3rd Fl | Washington, DC 20002 | P 202-442-5925 | F 202-442-4947 | dchealth.dc.gov SCHOOL HEALTH SERVICES …

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Section 1. To be completed by Parent or Guardian (Please Print)

WEB18 Perm # _____ DENTAL HEALTH CERTIFICATE Parent/Guardian: New York State law (Chapter 281) permits schools to request a dental examination in the following grades: …

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West Contra Costa Unified School District Oral Health …

WEBOral Health Assessment/Waiver Request Form. California law (Education Code Section 49452.8) states your child must have a dental check-up by May 31 of his/her first year in …

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COMMONWEALTH OF VIRGINIA

WEBallows a child an exemption from receiving immunizations required for school attendance if the student or the student’s parent/guardian submits an affidavit to the school’s admitting …

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ESCONDIDO UNION SCHOOL DISTRICT

WEBHealth #403 (Rev. 2/09) Medical Authorization and Plan form Eng/Span ESCONDIDO UNION SCHOOL DISTRICT MEDICATION AUTHORIZATION AND PLAN This form is …

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HCS Student Enrollment Reference Guide

WEBHCS Student Enrollment Reference Guide AA-P2-R1 HCS Student Enrollment Reference Guide Page 2 of 3 Date of Revision: March 19, 2015 Age Verification The parent is …

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Sanger Unified School District New Student Health …

WEBTitle: Microsoft Word - HEALTH REG FORM 2018 revised.docx Created Date: 20180228181540Z

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PowerSchool Enrollment

WEBH511.336(Rev. 9/2012) Page 1 of 4: STUDENT HISTORY pennsylvania DEPARTMENT OF HEALTH Bureau of Community Health Systems Division of School Health

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2023-2024 School Year Request for Administration of …

WEBNew Albany-Floyd County Consolidated School Corporation Health Services 2023-2024 School Year Request for Administration of Medication To be completed by prescribing …

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