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Get RI School Physical Form 2016-2024

All districts must accept this form. General health examinations shall be documented in a standardized format with one copy available from the Rhode Island Department of Health or in any such format that captures the same fields of information (R16-21SCHO Section 8.4) Student Name: Last First Middle Address: Street Apt # City State Date of Birth Sex Zip Code Home Phone PLEASE COMPLETE ALL INFORMATION BELOW (May attach immunization transcript). IMMUNIZATIONS Please enter dates in MM/DD.

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