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
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 families
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 his/her 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 to
be administered in school, you must have the physician complete a medication administration form
for each medication. This form can be obtained from your child’s school. If you do not have access
to a physician or nurse practitioner or if your child requires a special individualized health procedure,
please contact the principal and/or nurse in your child’s school.
Please complete this Physical Examination form and
return it to your child’s school as quickly as possible.