The Child & Adolescent Health Examination Form, also known as CH 205, is a medical form required by the New York City Department of Health & Mental Hygiene for students enrolling in NYC public and private schools. Parents or guardians complete the demographics section, while a licensed healthcare practitioner fills out the physical examination results, immunizations, and any recommended follow-up care.
The form is required for students entering kindergarten, grade 3, grade 7, and grade 10 in NYC, as well as for any student enrolling in a New York City school for the first time. The healthcare practitioner documents blood pressure readings, blood lead level (BLL) test results, height and weight, developmental and nutritional assessments, and hearing and vision screening outcomes. The practitioner must also record all immunizations received and note recommended follow-up care or specialist referrals. A signed page from a licensed provider is required before the school will accept the form.
Completing this nyc physical exam form accurately ensures that school health staff can support each student's well-being, identify any health conditions requiring accommodation, and coordinate care with parents and providers. Schools may require the form before the academic year begins or within 30 days of enrollment. Once submitted, the signed page becomes part of the student's permanent health record. Parents and guardians should retain a copy and bring it to each well-child visit so the healthcare practitioner section remains current for future NYC school health requirements.
| Question | Answer |
|---|---|
| Form Name | Child Adolescent Health Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | ch 205 form, ch 205 health exam, child and adolescent health examination form nyc, ch205 |
