School District*
County*
School Name*
Street Address 1* (No P.O. Box)
Street Address 2
City* (PA Only)
Zip Code* (i.e. 17000)
Name* (First and Last)
Phone Number* (i.e. 7175551212)
Email Address
Please indicate the number of packages requested. The number of forms per package is indicated after the form name.
Use only numbers (0-9). Do not use letters/words. If no forms are needed, leave blank.
Dear Parent/Guardian/Dear Physician (Scoliosis Follow-up), 2000 (100/pkg)- AVAILABLE UNTIL SUPPLY DEPLETED
School Health Record (2 page, back-to-back), 2003 (50/pkg)
School Health Record - 24 Page Booklet (Nurse Practitioner Program), 1988 (25/pkg) - AVAILABLE UNTIL SUPPLY DEPLETED
Private Physician's Report of Physical Examination, 2002 (500/pkg)
School Dental Record, 1999 (250/pkg)
Private Dentist Report of Dental Examination of School Age Pupils (100/pkg)
Girls Growth/BMI Chart - 2 to 20 years, 2003 (250/pkg)
Boys Growth/BMI Chart - 2 to 20 years, 2003 (250/pkg)
School Personnel Health Record (Employees), 2000 (100/pkg)
Progress Notes (Additional Page of School Health Record) - NO LONGER AVAILABLE FOR ORDER - MUST BE DOWNLOADED FROM WWW.HEALTH.STATE.PA.US/SCHOOLHEALTH
The following guidelines/manuals/legal references can no longer be ordered and must be downloded from the Division of School Health's website at www.health.state.pa.us/schoolhealth.
Procedure Manual - School Immunization Regulations, 2004
Request for Reimbursement & Report of School Health Services Instruction Manual, 2006
Guidelines for Care: Children Assisted by Medical Technology in Education Settings, 1989
Procedures for Dental Health Program in Schools
Guidelines for Documentation & Maintenance of School Health Records, 1988 (Nurse Practitioner Program)
Procedures for Growth Screening Program in Schools, 2004
Procedures for Hearing Screening Program in Schools, 2001
Guidelines for Indoor Air Quality in Pennsylvania Schools, 2002
Procedures for School Based Program for Control of Lice, Scabies & Ringworm (currently unavailable)
Procedures for Scoliosis Screening Program in Schools, 2001
Procedures for Vision Screening Program in Schools, 2002
Communicable and Noncommunicable Disease Regulations
Pennsylvania Public School Code - School Health Articles (Statutes)
School Health Regulations
Thank you for your using our new online Stock Requisition form. Please click the "Submit" button to send your request to the Division of School Health.
If you have any questions regarding your order, please call the Division of School Health at (717) 787-2390.
If you would like to order Immunization Cards, please call the Division of Immunizations at (717) 787-5681.
