School entry exams, medication authorizations, dental and eye certificates, child care health reports and staff exams, grouped by state, plus camp and DoDEA forms.
Schools, child care programs and camps need a clinician's signature before a child can enroll or take medication on site. The forms clinicians see most are school entry exams, such as Illinois' Certificate of Child Health Examination, Connecticut's Health Assessment Record (HAR-3) and Virginia's School Entrance Health Form (MCH 213G), and medication orders like Maryland's School Medication Administration Authorization Form. This hub lists 78 forms by state, along with dental and eye certificates, child care health reports, staff exams and the national camper health form.
On the exam forms, the parent fills in the history and the clinician completes the exam, immunizations and signature; most go back to the school through the parent. Some must be renewed: DC's Universal Health Certificate every year, and Maryland's medication form yearly or when the dose changes. Dental and eye certificates are for dentists, hygienists, optometrists and ophthalmologists. Of these forms, 22 have a Spanish version. Vero Documents fills PDF forms from the visit note and the chart, and the clinician reviews and signs.
DoDEA Form 1307Physician and dentist certify that a child enrolling in DoDEA's Sure Start pre-kindergarten program is in satisfactory health, free of communicable disease, and up to date on immunizations.
National model camper health form: parent health history (Form 1) plus the child's health-care provider review, activity restrictions and recommendations (Form 2) for day and resident camps.
Proof of the oral health assessment required by May 31 for children in kindergarten or first grade if not previously enrolled (Education Code 49452.8).
Pre-admission medical assessment and immunization record required for a child entering a licensed child care center (22 CCR 101220).
Health screening (general health, TB) showing a licensee, employee or volunteer can perform their duties in a licensed community care or child care facility.
Physician's evaluation and written instructions allowing child care staff to provide G-tube feeding, hydration or liquid medication.
Prescriber order and parent authorization required before school nurses, child care staff or youth camp staff give a medication (Conn. Agencies Regs. 10-212a).
Health assessment required for children enrolling in licensed child care centers, group child care homes and preschool programs (ages birth to 5).
Registro de la Evaluación de Salud
Documents the health assessment (physical, oral health screening, immunizations) required before public school entry and again in grade 6 or 7 and grade 9 or 10 (C.G.S. 10-204a, 10-206).
Provider order and parent authorization for medications and medical procedures to be given at school (D.C. Code 38-651.03); renewed annually.
Annual dental provider assessment required for students in DC schools and child care (D.C. Code 38-602).
Certificado Universal de Salud
Annual health certificate required for every child attending DC public, charter, private schools, child care and youth programs (D.C. Code 38-602): physical exam, immunizations, screenings, health history.
DH 3040Certifies the health examination required within one year before entry into a Florida school (s. 1003.22, F.S.); also used for child care/pre-K entry.
Certifies the vision, hearing, dental and nutrition screening required for children entering a Georgia public school (any grade) or within 12 months of entry.
Form 14Required health record for entry to a Hawaii school or preschool: physical examination within one year before entry and before 7th grade, plus immunizations.
Certifies TB clearance (risk assessment, symptom screen, TST/IGRA or CXR) required for school, child care and other settings in Hawaii.
Supplement to DOE Form 14 recording developmental, vision, hearing and other screenings and special care needs for children in licensed child care/preschool.
DHS 984Medical report and TB clearance for child care applicants, employees and household members in licensed child care facilities.
Certificado de Examen de Salud Infantil
Documents the required school/child care health examination (history, physical, immunizations, lead, diabetes and TB risk, developmental/social-emotional screening) for Illinois school entry, grades K, 6 and 9, and child care enrollment.
Proves the dental examination required for children in kindergarten and grades 2, 6 and 9 (77 Ill. Adm. Code 665), with oral health status and treatment needs.
Proves the eye examination required for children enrolling in an Illinois school for the first time (kindergarten or first entry), due by October 15.
Pre-employment and periodic medical report (TB test, immunization status, findings and fitness) for staff, volunteers and household members in DCFS-licensed child care.
IDPH V-4Eye doctor's report back to the school after a child is referred from the state vision screening program.
Proof of the dental screening required for children newly enrolling in kindergarten and ninth grade in Iowa (Iowa Code 135.17).
470-0021Proof of the child vision screening required for kindergarten and third grade enrollment (Iowa Code 135.39D / 641.52), with an eye-exam section for referrals.
Child Care Provider Physical Examination Report (Spanish, 470-5152(S))
Physical examination, immunization consultation and TB screening required for child care center personnel and child development home providers.
Child health assessment required no later than 60 days after enrollment in a Kansas licensed child care facility, including providers' own children.
Documents the preventive health care examination required within 12 months before first entering a Kentucky public school and within one year before entry to sixth grade (702 KAR 1:160).
Proof of the vision examination required (KRS 156.160) by January 1 of the first year a child aged 3-6 enrolls in public preschool or primary school.
Proof of the dental screening or examination required (KRS 156.160) for children aged 5 and 6 entering public school.
Medical examination (with TB screening) required for school employees under 702 KAR 1:160.
Sample school medication authorization with parent consent and a healthcare provider statement/order for medication during school hours.
Biennial certification that a nursery school licensee/staff member is free from communicable disease (22 M.R.S. 8402).
Prescriber's authorization (valid one year) and parent consent for school staff to give a medication at school.
Documents the physical examination required for students entering a Maryland public school for the first time (COMAR 13A.05.05.07).
MDH 4620Certifies blood lead test dates and results (or documents parental refusal) required before entry into child care, pre-kindergarten, kindergarten or first grade in Maryland.
OCC 1215Health inventory required for children entering licensed child care or nursery school (COMAR 13A.15-13A.18): parent history plus provider child health assessment.
Authorized prescriber's order and parent consent for medication given to a camper at a Maryland youth camp (COMAR 10.16.07).
Medical evaluation of child care providers, staff and household members showing they can safely care for children of the ages served.
Prescriber order and parent consent for medication administration in Maryland licensed child care.
Combined asthma action plan and prescriber authorization for asthma medication in Maryland licensed child care (used instead of OCC 1216).
Allergy/anaphylaxis emergency plan and prescriber authorization for epinephrine and antihistamines in Maryland licensed child care (replaces OCC 1216 for these medications).
Seizure action steps and prescriber authorization for seizure/emergency medication in Maryland licensed child care (used without OCC 1216).
Standard provider examination form shared with the school to document the physical examinations required by M.G.L. c.71 s.57 (school entry, grades 1, 4, 7, 10).
Medical examination required for family child care licensees, certified assistants and household members caring for children in a licensed family child care home.
MDHHS-3305Child health appraisal (exam, screenings, immunizations) used for enrollment in licensed child care centers, preschool/GSRP and school entry so the program can meet the child's health needs.
CCL-3704Physician statement requested by child care licensing on whether an applicant, licensee or household member has a physical or mental condition affecting the care of children.
MS-2083Health care source's summary of a child's physical exam and health status required at enrollment in a Minnesota licensed child care center (Minn. R. 9503.0070).
Medical examination report required for infants, toddlers and preschool children enrolling in Missouri licensed child care.
Medical examination certifying that a child care provider, staff member or household member is free of communicable disease and able to care for children.
Declaración de Salud Pediátrica
Medical professional's statement on a child's health required for enrollment in Montana licensed child care (ARM 37.95.128).
Care plan for a child with special health needs or ongoing medication in licensed child care, approved by the child's health care provider.
Documents the visual evaluation required for school entry at the beginner grade and for out-of-state transfers (Neb. Rev. Stat. 79-214).
Convenience form documenting the physical examination required for school entry (kindergarten/beginner grade), seventh grade and transfers from out of state (Neb. Rev. Stat. 79-214).
Short provider certificate that the required school physical examination was completed (alternative to the full FH-42 report).
Standard health record documenting a child's physical exam, immunizations and screenings for child care centers, preschool and school entry and WIC.
Documents the physical examination required for new entrants and students in grades pre-K/K, 1, 3, 5, 7, 9 and 11, sports participation, working papers and CSE/CPSE.
Optional certificate a school may request showing a dental health assessment within the past 12 months (Education Law 903).
Formulario de Evaluación de Salud y Transmisión de Carolina del Norte
Transmits the health assessment required within 12 months before a child first enters a North Carolina public school (G.S. 130A-440).
Children's Medical Report (Español)
Physical examination report required for children enrolling in North Carolina licensed child care centers and family child care homes.
Pre-employment statement that a child care center staff member is emotionally and physically fit to care for children (10A NCAC 09 .0701).
TB risk questionnaire and test results required for child care center staff and family child care home operators (10A NCAC 09 .0701, .1702, .1729).
Health care professional's waiver allowing an infant in child care to sleep in an alternative position or use a wedge (10A NCAC 09 .0606(e), .1724(e)).
CD 51Health assessment and immunization record required for children in certified child care centers, group and family child care homes (55 Pa. Code 3270.131, 3280.131, 3290.131).
Records the mandated school physical examination (school entry, grade 6, grade 11) by a private or school physician.
Reports a private dentist's examination for the mandated school dental exams (original entry, grade 3, grade 7) and dental hygiene services program.
Initial and biennial health assessment (including TB testing) for child care staff (55 Pa. Code 3270.151, 3280.151, 3290.151).
H511.340Post-offer physical examination and TB testing record for school employees (24 P.S. 14-1418).
Physician report on a child care provider/applicant's physical and mental fitness for approval, licensure or employment in child care.
Records the state-required vision screening for children in school/child care and the follow-up eye examination after a failed screening.
Health care professional's recommendation allowing an infant in a licensed child care operation to sleep in a position or equipment other than on the back in a crib.
Mancomunidad de Virginia Formulario de Salud Para El Ingreso Escolar
Required school-entry health form: Part II certification of immunization and Part III comprehensive physical examination report for children entering Virginia public kindergarten or first grade, or entering from out of state.
VDOE model form: parent authorization and physician certification that a medication must be given in a licensed child day center.
Sample form for the licensed healthcare provider's request and parent authorization required before school staff give medication (RCW 28A.210.260).
ECE-CC-3Health assessment required for children enrolled in West Virginia licensed child care (a HealthCheck exam report may be attached instead).
ECE-CC-3CMedical history and examination report for child care providers showing they can safely care for children.
DCF-F-CFS0060-EInforme de Salud Infantil - Centros de Cuidado Infantil
Health examination report required for children enrolling in Wisconsin licensed child care centers (DCF 251), repeated per age schedule.
DCF-F-CFS0054Health examination report showing a child care center staff member is physically able to care for children (DCF 251.05).
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Illinois requires the exam for school entry, for kindergarten, sixth and ninth grade, and for child care enrollment, and the parent returns it to the school by October 15. Exams done after January 1, 2025 must use the updated form, which adds social-emotional and developmental screening. The clinician completes pages 2 and 3: the physical, screenings, immunization verification and signature. A Spanish version, the Certificado de Examen de Salud Infantil, is available.
An authorized prescriber. Connecticut's Authorization for the Administration of Medication by School, Child Care, and Youth Camp Personnel accepts a physician, dentist, APRN, PA, optometrist or podiatrist, and one form covers schools, licensed child care and youth camps. Maryland's school form accepts a physician, NP, PA or dentist. It is valid for one year: a new form is needed each year for each medication, and whenever the dose changes. The parent signs the consent section on both.
Yes. The MCH 213G is available in Spanish and in Arabic, Chinese, Dari, Korean, Pashto, Russian, Swahili, Tagalog, Ukrainian and Vietnamese. The parent completes Part I. The clinician completes Part II, the certification of immunization, and Part III, the comprehensive physical examination report. The physical must be done within 12 months of school entry. The form is fillable and has an electronic signature checkbox.
New entrants, and students in pre-K or kindergarten and grades 1, 3, 5, 7, 9 and 11. The same form covers sports participation, working papers and CSE or CPSE evaluations. A private physician, NP or PA, or the school medical director, completes the health history, exam, screenings and activity clearance. It goes to the school through the parent or directly to the school health office. New York City public schools use their own CH-205 form.