Mayfield Jr./Sr. High School

Jon Peterson


27 School Street

Mayfield, NY 12117



Jr/Sr High School



Elementary School


leaf bullet K-12 Health Requirements



June 18, 2018


The following items are a current listing of New York State health requirements for
School Attendance Grades K-12.

o PHYSICAL EXAMINATION Due within 30 days of starting school
As of July 1, 2018 New York State Law requires all new entrants, Pre K or K, 1, 3, 5, 7, 9, & 11 graders and
those participating in sports to have a health examination by a New York State licensed provider and on the
approved NYSED student health examination form for school. Acceptable heath exams may be dated anytime
within the 12 months prior to the start of the current school year in which they are requested. Forms are
available on the district website, see Health Services.
If you do not want your child to be examined at school, please inform the school nurse
and provide the required health examination form.

o IMMUNIZATIONS Due within 14 days of starting school
Acceptable proof of immunity for school attendance must be one of the following:
1. An Immunization certificate SIGNED by a NYS provider.
2. Immunization Registry report (NYSIIS, CIR or Registry from another state), an electronic health
record or official record from a foreign nation.
3. Serological evidence of immunity (titer) for the following diseases: mumps, measles, rubella,
varicella (chicken pox), Hepatitis B or all 3 serotypes of poliomyelitis.
4. NYS health care provider (MD, NP, PA) diagnosis of varicella (chicken pox)
(Please note parental recall of disease history cannot be accepted as evidence of immunity.)

Vaccine Name-----*Number of doses required for School K-12*

  • Diphtheria, Tetanus, Pertussis (DTP, DTaP)-----4-5* (3 doses grades 10-12)

  • Hepatitis B (Hep B)-----3*

  • Measles, Mumps, Rubella (MMR)-----2* doses Measles, Mumps, 1 dose Rubella

  • Meningococcal-----1* (grades 7,8,9)-----2* doses (grade 12)

  • Polio (IPV or OPV)-----3-4*

  • Tetanus, Diphtheria, & Pertussis Booster (Tdap)-----1* (grades 6-12)

  • Varicella (chicken pox)-----2* (enrolling in grades K, 1, 2, 3, 4, 6, 7, 8, 9, 10) (1 dose all other grades)

*Number of doses must be given at correct intervals based on age (ACIP schedule), please review with your
provider* ACIP schedule can be found at:

Each student is requested to furnish a dental health certificate describing their dental health condition dated not
more than twelve months prior to the beginning of the school year in which the examination is requested.
Forms are available on district website, see Health Services.

Janine Kilpatrick, R.N., High School Nurse’s office: (518)661-8211 Fax: (518)661-7666
Rebecca Lestage, R.N., Elementary School Nurse’s: (518)661-8254 Fax: (518)661-6590