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Get School Physical Maryland Form 2020-2024

Student Record Card 6 Maryland State Department of Education MONTGOMERY COUNTY PUBLIC SCHOOLS MCPS Rockville Maryland MCPS Form SR-6 March 2016 Page 1 of 4 MARYLAND SCHOOLS RECORD OF PHYSICAL EXAMINATION To Parents or Guardians In order for your child to enter a Maryland public school for the first time the following are required A physical examination by a physician or certified nurse practitioner must be completed within nine months prior to entering the public school system or within six months after entering the system. A physical examination form designated by the Maryland State Department of Education and the Department of Health and Mental Hygiene must be used to meet this requirement. Evidence of complete primary immunizations against certain childhood communicable diseases is required for all students in preschool through the twelfth grade. A Maryland Immunization Certification form for newly enrolling students may be obtained from the local Department of Health and Human Services or from school personnel* The form and the required immunizations must be completed before a child may attend school* Form DHMH 896. Evidence of blood testing is required for all students who reside in a designated at risk area when first entering Pre-kindergarten Kindergarten and 1st grade. The blood-lead testing certificate DHMH 4620 or another written document signed by a Health Care Practitioner shall be used to meet this requirement. Exemptions from a physical examination and immunizations are permitted if they are contrary to a student s or family s religious beliefs. Students may also be exempted from immunization requirements if a physician/nurse practitioner or health department official certifies that there is a medical reason not to receive a vaccine. Exemptions from Blood-Lead testing is permitted if it is contrary to a family s religious beliefs and practices. The Blood-Lead certificate must be signed by a Health Care Practitioner stating a questionnaire was done. The health information on this form will be available only to those health and education personnel who have a legitimate educational interest in your child. In order to assist your child in gaining the most from their educational experience please complete Part I of this Physical Examination form* Part II must be completed by a physician or nurse practitioner or attach a copy of your child s physical examination to this form* If your child requires medication and or a treatment to be administered in school you must have the physician complete a medication forms can be obtained from your child s school or online from the Montgomery County Public Schools MCPS website MCPS Form 525-12 Authorization to Provide Medically Prescribed Treatment Release and Indemnification Agreement MCPS Form 525-13 Authorization to Administer Prescribed Medication Release and Indemnification Agreement MCPS Form 525-14 Emergency Care for the Management of a Student with a Diagnosis of Anaphylaxis Release and Indemnification Agreement for Epinephrine Auto Injector.

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