Elementary Schools

Temple Elementary Health Services

Temple Nurse:

Mrs. Melissa Town, RN, BSN

mtown@falconerschools.org

Phone - 716-267-3255 option 1

Fax - 716-267-9420

Chautauqua Center offers immunizations, physical exams, and dental exams for children and adults that are having trouble with their insurance or have no insurance. They also have advocates to help you get the coverage you need!

Location: 110 E. 4th St. Jamestown, NY 14701
Phone: 716-484-4334
Hours: Monday-Thursday 8 am-6 pm and Friday 8 am-5 pm

Immunizations must be up to date within the first 14 days of school or let the nurse know about scheduled appointments if on a catch-up schedule.

New York State law requires a health examination for all students entering the school district for the first time and when entering Pre-K, K, and 1st grade. The examination must be completed by a New York State licensed physician, physician assistant, or nurse practitioner within the past year starting from the first day of school.
- A copy of the health examination must be provided to the school within 30 days from when your child first starts at school, and when your child starts Pre-K or K, 1st, 3rd, 5th, 7th, 9th & 11th If a copy is not given to the school within 30 days, the school will contact you.
- If your child has an appointment for an exam during this school year that is after the first 30 days of school, please notify the Health Office of the date.
- Communication between private and school health staff is important for safe and effective care at school. Your healthcare provider may not share health information with school health staff without your signed permission. Please talk to your provider about signing their consent form for the school at the time of your child’s appointment for the examination.
Dental Van- is available by appointment and changes locations monthly. To make an appointment, call 716-560-5127. They provide exams, cleanings, fillings, and X-rays. Ages 2-20. They take Medicaid and Fidelis. If you have no insurance, you can get a discounted rate. For other insurance providers, you will need to send the paid bill for reimbursement.

We suggest you make copies of the completed forms for your own records before sending them to the school health office. Forms may be faxed to Temple at 716-267-9420

Universal Pre-K Requirements

PHYSICAL

You have 30 days from the first day of school to submit a physical

exam from your doctor to the Health Office (a physical within the

past 12 months is acceptable), OR you must call the Health Office

with a scheduled appointment date

IMMUNIZATION
RECORD

VARICELLA 1 DOSE

(Chicken pox vaccine)

DTaP/DTP/Tdap: 4 DOSES

(Diptheria Toxoid/ Diptheria, Tetanus, Pertussis Vaccine)

IPV: 3 DOSES

(Polio vaccine)

MMR: 1 DOSES EACH of the Measles, Mumps, and Rubella
(Measles, Mumps, Rubella vaccine)

HEPATITIS B: 3 DOSES

HIB: 1 to 4 DOSES
(Haemophilus influenzae type b conjugate vaccine)

PCV: 1 to 4 DOSES
(Pneumococcal Conjugate Vaccine)

PCV 13: Preferred vaccine for pneumonia

LEAD LEVEL

TEST

Usually done at an early age, a lead level is required

(not mandatory), to be submitted to the Health Office within

3 months from the first day of school. Your doctor should already

have the results. If not, it is your choice to have your child tested.

NYS Public Health Law, Article13, Title 10, Section 1370-1376-A,

wants parents to be informed of the risks of lead.

DENTAL EXAM

A DENTAL FORM IS OPTIONAL FOR PRE-K

Other Forms you
will need to

submit

Birth certificate (copy)
Proof of residency, such as utility bill, tax receipt, rent receipt.
School-provided Home Language Questionnaire Form
School-provided Confidential Enrollment Form
School-provided Health and Contact Form
School-provided Transportation Form
Signed Request for Student Records Form, for transferring students

Medical exemptions for immunizations must be reissued yearly. Students who are not fully immunized must call the health office with an appointment date or they will be excluded from school after the 14th day.

Serologic proof of measles, mumps, rubella, hepatitis B, varicella, or polio antibodies is acceptable proof of immunity. Diagnosis by a doctor that a child has had varicella is acceptable proof of immunity. For further information contact: NYS Department of Health, Bureau of Immunization.

A packet containing these forms to enroll your child is available at the Temple Office

OFFICE PHONE: 716-267-3255 HEALTH OFFICE: 716-267-3255 FAX:716-267-9420

Requirements for students entering Kindergarten

PHYSICAL

You have 30 days from the first day of school to submit a physical

exam from your doctor to the Health Office (a physical within the

past 12 months is acceptable), OR you must call the Health Office

with a scheduled appointment date.

IMMUNIZATION
RECORD

VARICELLA: 2 DOSES

(Chicken pox vaccine)

DTaP/DTP/Tdap: 4 to 5 DOSES
(Diptheria Toxoid/ Diptheria, Tetanus, Pertussis Vaccine)

IPV: 3 to 4 DOSES
(Polio vaccine)

MMR: 2 DOSES

(Measles, Mumps, Rubella vaccine)

HEPATITIS B: 3 DOSES

HIB: Not required for Kindergarten
(Haemophilus influenzae type b conjugate vaccine)

PCV: Not required for Kindergarten
(Pneumococcal Conjugate vaccine)

LEAD LEVEL
TEST

Usually done at an early age, a lead level is required

(not mandatory), to be submitted to the Health Office within

3 months from the first day of school. Your doctor should already

have the results. If not, it is your choice to have your child tested.

NYS Public Health Law, Article13, Title 10, Section 1370-1376-A,

wants parents to be informed of the risks of lead.

DENTAL EXAM

Is optional for students entering Kindergarten

Other Forms you
will need to

submit

Birth Certificate (Copy)
Proof of Residence, such as utility bill, tax receipt, rent receipt
School-provided Home Language Questionnaire Form
School-provided Confidential Enrollment Form
School-provided Health and Contact Form
School-provided Transportation Form
Signed Request for Student Records Form, for transferring students

Medical exemptions for immunizations must be reissued yearly. Students who are not fully immunized must call the health office with an appointment date or they will be excluded from school after the 14th day. Serologic proof of measles, mumps, rubella, hepatitis B, varicella, or polio antibodies is acceptable proof of immunity. Diagnosis by a doctor that a child has had varicella is acceptable proof of immunity. For further information contact: NYS Department of Health, Bureau of Immunization

A packet containing these forms to enroll your child is available at the Temple Office

OFFICE PHONE: 716-267-3255 HEALTH OFFICE: 716-267-3255 option 1 FAX: 716-267-9420

REQUIREMENTS FOR 1ST AND 2ND GRADE

PHYSICAL

Only 1st GRADERS need to submit a physical

or call the Health Office with a scheduled

appointment date. A physical done within the

last 12 months is acceptable.

IMMUNIZATION
RECORD

VARICELLA: 2 DOSES

(Chicken pox vaccine)

DTaP/DTP/Tdap: 4 to 5 DOSES

(DiptheriaToxoid/Diptheria,Tetanus, Pertussis)

IPV: 3 to 4 DOSES
(Polio vaccine)

MMR: 2 DOSES

(Measles, Mumps, Rubella vaccine)

HEPATITIS B: 3 DOSES

HIB: Not required for grades 1 and 2
(Haemophilus influenzae type b conjugate)

PCV: Not required for grades 1 and 2
(Pneumococcal Conjugate vaccine)

DENTAL EXAM

A Dental form is optional for 1st and 2nd

grade students

Medical exemptions for immunizations must be reissued yearly
Students who are not fully immunized must call the health office with an appointment date or they will be excluded from school after the 14th day. Serologic proof of measles, mumps, rubella, hepatitis B, varicella or
polio antibodies is acceptable proof of immunity. Diagnosis by a doctor that a child has had varicella is acceptable proof of immunity.

For further information contact: NYS Department of Health, Bureau of Immunization

OFFICE PHONE: 716-267-3255 HEALTH OFFICE: 716-267-3255 FAX: 716-267-9420