Health Information and Forms


Below you will find the four forms required by The School District of Philadelphia. Information about theses forms and links to access them can be found below.

You will also find an immunization calendar. If you have any questions or concerns please contact the school at 215-400-7480.

  • S865 – to be completed by parent to inform nurse of any medical condition/medication use.
  • MED-1– to be completed by students Doctor for medication use during school – including over the counter medication.
  • MED-1 (Asthma)– to be completed by students Doctor for Asthma rescue inhalers.
  • MEH-1-Report of physical examination, to be completed by students Doctor.
  • MEH-155– Dental Examination Form

Does your child have a health condition we need to know about?
As the school nurse at Alexander Adaire Elementary School, I would like to know about your child’s health condition.  Please complete the form (S865) and return it to the nurse as soon as possible.

If your child requires medication in school, please contact the nurse or send your child to the health room for the proper form (MED-1) or (MED-1 (Asthma) to be completed by your child’s doctor.  For everyone’s safety, students ARE NOT permitted to bring any medications into school without written permission from the parent, doctor, and the approval of the school nurse.  This includes asthma inhalers and over the counter medications.

Immunization Requirements:

List of School Required Immunizations

Immunization Requirements Guide

Required Physical and Dental Exams:

Physical Examinations (MEH-1) are required when entering Kindergarten or 1st Grades, 6th Grade, and 11th Grade.

Dental Examinations (MEH-155) are required when entering Kindergarten or 1st Grades, 3rd Grade, and 7th Grade.

Health Center List:

List of Federally Qualified Health Centers

If your student or family member is in need of care, please consider using one of the city’s Federally Qualified Health Centers (FQHCs). FQHCs are community-based organizations that provide comprehensive primary and preventive care including health, oral, mental health/ substance abuse services to persons of ALL ages, regardless of ability to pay or health insurance status. Please call ahead to confirm hours and available services at each center.

COVID Information HUB

Click here to access the school district’s COVID-19 Information Hub. Families and staff can use this site to find direct links to COVID related information and resources for the School District of Philadelphia. SDP will continue to work closely with the Philadelphia Department of Public Health (PDPH) to strengthen health and safety protocols. Please check back often for the most recent information.