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Get NY Public School Physical Exam Form

Am for new entrants and students in Grades Pre-K or K, 1, 3, 5, 7, 9 & 11; annually for interscholastic sports; and working papers as needed; or as required by the Committee on Special Education (CSE) or Committee on Pre-School Special education (CPSE). STUDENT INFORMATION Name: Affirmed Name (if applicable): DOB: Sex Assigned at Birth: Female Male School: Gender Identity: Female Male Nonbinary X Grade: Exam Date: HEALTH HISTORY If yes to any diagnoses below, check all.

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