Hawaii Form 14 Student's Health Record (DOE)

Hawaii law requires physical examination, immunization and tuberculosis clearance before a child attends child care, preschool, or public or private school. The Student's Health Record, Form 14, documents the physical exam and immunizations. The exam must be done within one year before the first day at a Hawaii preschool or school, and again within one year before seventh grade.

Who completes it

A physician, APRN or PA licensed in the U.S. completes and signs the physical examination and immunization sections.

Submitting and payment

How to submit it
Return it to the parent, who submits it to the school or preschool.

Good to know

  • TB clearance is a separate requirement: the Department of Health's TB Form F is the clearance document providers complete.
  • Students missing immunization or physical exam documentation may get provisional entry with verification of an upcoming medical appointment.
  • Only medical and religious exemptions are allowed; medical exemptions come from the child's health care provider and religious exemption forms from the school.
  • For licensed child care and preschool, the DHS 908 Early Childhood Pre-K Health Record Supplement is used together with Form 14.

Get the official form

Download the current version from the source each time; forms change without notice.

Student's Health Record

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

How this list is checked

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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Frequently asked questions

When must the Hawaii Form 14 physical be done?

Within one year before the student's first day at a Hawaii preschool or school, and within one year before the first day of seventh grade. Students without documentation may be allowed provisional entry with verification of an upcoming medical appointment.

Does Hawaii Form 14 cover TB clearance?

No, TB clearance is a separate requirement handled with the Department of Health. Hawaii's school health page lists TB Form F, the State of Hawaii TB Clearance Form, as the document, along with an acceptable clearance document list and TB testing FAQs.

Who can sign the Hawaii Student's Health Record?

A physician, APRN or PA licensed in the United States completes and signs the physical examination and immunization sections. The current edition is RS 22-1004, revised May 2022, and the Department of Education requires it for all children entering school.