top of page

Health Forms

These forms are required of all students attending NYS schools. Please be sure to have your Dr. use THESE State forms provided. We can not accept any other forms submitted.

Immunization Requirements
Immunization Report
Required State Health Form
Health History

Other forms should it apply to your child;
Food Allergy
Bee Allergy Form
Asthma Emergency Health Care Plan
Permission to Administer Medication

​Medical Exemption

Vaccination Guidelines 

  • PDF to Print

    On June 13, 2019 Governor Andrew M. Cuomo signed new legislation removing non-medical exemptions from school vaccination requirements for children attending public, private, or parochial school (pre-kindergarten through 12th grade), or child day care settings. Religious exemptions are no longer valid in New York State. To attend or remain in school or day care, students must receive the first age-appropriate dose in each immunization series within 14 days of the first day of school or day care. In addition, parents/legal guardians are required to show proof that they have appointments in place for the required follow-up doses within 30 days after the first day of school or day care. The deadline for follow-up doses depends on the vaccine and must be in accordance with the vaccine recommendations and guidelines of the ACIP. If a child has a medical contraindication to a specific immunization(s), the parent/legal guardian must provide a valid medical exemption form that is signed and confirmed annually by a New York State licensed physician.
    You are responsible for promptly notifying the local health department when a student is not in compliance with Public Health Law $2164. You are also required to maintain a current list of susceptible (unvaccinated or undervaccinated) students at all times. Each year, the New York State Department of Health conducts an audit of schools for compliance with PHL $2164. Audits may be conducted remotely or in person. If during an audit a student is found to be out of compliance, he/she will be required to be excluded from school until they come into compliance. Noncompliant schools may be subject to civil penalties depending on the reason for the violation or noncompliance. "Education Law $310 provides that persons considering themselves aggrieved by an action taken at a school district meeting or by school authorities may appeal to the Commissioner of Education for a review of such action." While an appeal is pending before the Commissioner, a request for a "stay may be submitted by the petitioner.
    You may refer uninsured/underinsured students through 18 years of age to our Vaccines for Children (VFC) immunization clinics located in Goshen and Newburgh. Appointments can be scheduled by calling 845-360-6587. Please contact us if you need assistance reviewing medical exem translating immunization records. If you do not have a New York State Immunization Information System (NYSIIS) or Citywide Immunization Registry (CIR) account, please contact us so that we may assist you. Thank you all for your continued work towards the health of the Orange County community.
    Best regards,
    Dr. Irina Gelman, DPM, MPH, PhDc Commissioner of Health

    References:1. Governor Andrew M. Cuomo Signed Legislation Removing Non-Medical Exemptions from
    School Vaccination Requirements:
    2. 2019-20 School Year New York State Immunization Requirements for School
    3. NYSDOH Frequently Asked Questions About Legislation Removing Non-Medical
    Exemptions from School Vaccination Requirements #1: vaccine exemption faq.pdf
    4. NYSDOH Frequently Asked Questions About Legislation Removing Non-Medical
    Exemptions from School Vaccination Requirements #2: requirements faq.pdf
    5. NYSDOH Medical Exemption Statement for Children 0-18 Years of Age Medical Exemption
    Form for School Attendance:
    6. The ACIP Catch-up Immunization Schedule:
    7. General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory
    Committee on Immunization Practices (ACIP) - Contraindications and Precautions:
    8. Webinar from July 29, 2019 Regarding Non-medical Exemptions: vaccines/docs/immunization la
    W webinar.pdf
    9. Information Regarding Appeals to the Commissioner:

    PDF to Print - NYS DOH Vaccinations

    Effective June 13, 2019, Chapter 35 of the Laws of 2019 repealed non-medical exemptions from vaccination for children attending school.
    This document is in follow-up to FAQs issued on June 18, 2019 and on July 22, 2019. The Department of Health and the Office of Children and Family Services filed emergency regulations on August 13, 2019 to implement the statutory amendments to the Public Health Law and adhere to the legislative intent of the statutory amendments, which is to protect the public health. This guidance is intended to assist schools in implementing the statutory and regulatory amendments.
    The 2019-20 School Year New York State Immunization Requirements for School Entrance/Attendance is available online.
    The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) catch-up immunization schedule is available online.
    Public Health Law §2164, as amended by Chapter 35 of the Laws of 2019, applies to students attending all schools as defined in Public Health Law §2164 to include any public, private or parochial child-caring center, day nursery, day care agency, nursery school, kindergarten, elementary, intermediate, or secondary school.
    Public Health Law §2164, as amended by Chapter 35 of the Laws of 2019, prohibits a school from permitting any child to be admitted to such school, or to attend such school, in excess of 14 days without sufficient evidence that the child has received all age- appropriate required vaccinations. The 14 days may be extended to not more than 30 days where the student is transferring from out of state or from another country and can show a good faith effort to get the necessary evidence or where the parent, guardian or any other person in parental relationship can demonstrate that a child has received the first age- appropriate dose in each immunization series and that they have age-appropriate scheduled appointments for follow-up doses to complete the immunization series in accordance with the CDC’s Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 through 18.


TRANSPORTATION click on the pdf for easy download

Cornwall pdf
Monroe Woodbury pdf
​Goshen pdf
Middletown pdf
Newburgh pdf
Valley Central pdf
Washingtonville pdf

bottom of page