Kentucky Department of Education

 

School Health Forms

Last Updated on Saturday, May 19, 2012 at 8:27 PM

Documents on this web page are updated per statute and regulation and are intended for district use in fulfilling the requirements for school entry.

 

 

Vision Exam Form Vision Exam

Immunization Certificate

Immunization Certificate

Immunizations: Medical Exemption Certificate

Medical Exemption Certificate

Immunizations: Religious Exemption Certificate

Religious Exemption Certificate

Medical Examination of School Employees (this form is posted in PDF and Word)

The Commissioner's email from 1/21/11 explains the new requirements and timelines in detail:

1/21/11 Fast Five

Employee Exam Form Employee Exam Form

Kentucky High School Athletic Association (KHSAA) Sports Physical Exam

Sports Physical

Pupils Cumulative Health Record

Pupils Cumulative Health Record

Preventative Health Care Examination Forms

 

Preventative Health Care Exam K-4 Preventative Health Care Exam 6-12

School Health Services Reference Guide

HSRG

Dental Health Screening Form

Dental Health Screening Form
School Health Services Contract Template School Nurse Contract Template
For more information contact:

Karen Erwin
500 Mero Street, 15th Floor CPT
Frankfort, KY 40601
Phone: 502-564-5279
karen.erwin@education.ky.gov