Massachusetts State Seal An official website of the Commonwealth of Massachusetts Here's how you know

Official websites use .mass.gov

A .mass.gov website belongs to an official government organization in Massachusetts.

Secure websites use HTTPS

A lock icon or https:// means you've safely connected to the official website. Share sensitive information only on official, secure websites.

Skip to main content

School Health Record resources

Skip table of contents
You skipped the table of contents section.

Memos

Memorandum Health Care Provider's Examination: School Health Record, Open PDF file, 120.58 KB (English, PDF 120.58 KB)
Memorandum Health Care Provider's Examination: School Health Record, Open RTF file, 60.5 KB (English, RTF 60.5 KB)

Forms

Massachusetts School Record Form, Open PDF file, 104.94 KB (English, PDF 104.94 KB)
Massachusetts School Record Form, Open RTF file, 123.91 KB (English, RTF 123.91 KB)
Massachusetts School Health Record/Physical Examination Form, Open PDF file, 12.5 KB (English, PDF 12.5 KB)
Massachusetts School Health Record/Physical Examination Form, Open RTF file, 58.28 KB (English, RTF 58.28 KB)

Certificate

Certificate of Immunization, Open PDF file, 45.16 KB (English, PDF 45.16 KB)
Certificate of Immunization, Open DOCX file, 42.8 KB (English, DOCX 42.8 KB)

Help Us Improve Mass.gov  with your feedback

Please do not include personal or contact information.
Feedback