Student Health Services

Health Forms

Published: 5/26/2023 7:43 AM

Documents on this web page are updated per statute and regulation and are intended for district/school use in fulfilling the requirements for student health examinations.

Dental Screening/Exam

Kentucky law KRS 156.160 (j) requires proof of a dental screening or examination by a dentist, dental hygienist, physician, registered nurse, nurse practitioner, or physician assistant to be presented to the school no later than January 1 of the first year that a five (5) or six (6) year old child is enrolled in public school.

Dental Form

Immunizations

KRS 214. 034 requires any child enrolled as a regular attendee in all public or private primary or secondary schools, and preschool programs shall have a current immunization certificate and be on file within two weeks of the child’s attendance. Information including school immunization legislation and regulations, school immunization schedules, school immunization reporting forms and requirements can be found at the Kentucky Immunization Program Web site.

Preventative Health Care Examination of Students (School Physical)

702 KAR 1:160 requires each child first entering a Kentucky public school or entering Grade 6 to present a Kentucky Preventative Health Care Examination Form. This exam may be completed up to one year prior to initial entry.

Student Exam

Vision Exam Form

KRS 156.160 (1)(i) requires proof of a vision examination by an optometrist or ophthalmologist. This evidence shall be submitted to the school no later than January 1 of the first year that a three (3), four (4), five (5) or six (6) year old is enrolled in public school, public preschool, or Head Start program.

Vision Form

Sports Physical Form

To access the student sports physical form, visit the Kentucky High School Athletic Association website. At the bottom of the webpage in the lower left hand side, click the "KHSAA Forms" link. It can also be found by doing a internet search for "KHSAA Sports Physical Form".

Accessibility

We strive to ensure the pages of this website are accessible to individuals with disabilities. Every effort has been made to ensure the pages of this website are accessible to individuals with disabilities in accordance with Section 508 of the Rehabilitation Act.

Note: Some of the links on this site access non-governmental agencies. The information on these pages is not controlled by KDE or the Commonwealth of Kentucky.

Angie McDonald

Division of District Support

Office of Operations and Finance

300 Sower Blvd. – 4th Floor

Frankfort, KY 40601

Phone: (502) 564-5279 Ext. 4430

Angela.Mcdonald@education.ky.gov