Medical, Immunization, and Dental Requirements

There are several medical requirements for home educated students in Pennsylvania. There is considerable variation in how school districts handle this part of the home education law, and also considerable variation in how homeschoolers handle it. I find this to be the part of the law that has the widest range of interpretations in actual practice, therefore it is difficult to give clear guidelines. Every one of the 501 school districts seems to do it differently. I offer here several approaches and opinions - you will have to figure out what's right for your family -- what you are willing to give, and what your district will accept. If you have problems with your district, see my district problems page. If you need clarification, I suggest you call the homeschooling liaison at the PDE.

NOTE: This page applies to students who are homeschooled under PA's Home Education Law. Students who are too young to be registered with their district as home educated students do not have to comply with these requirements. There are no medical requirements for students who are privately tutored. Students who are enrolled in a public cyber-charter school school have requirements similar to those described on this page. Students who use another alternative to the PA Home Ed Law may have different requirements.

Medical and Dental Exam Requirements:

The following information about medical requirements for homeschooled students is taken from the PA Department of Education’s previous-but-one FAQ page (which was here, the previous one was here, the most current is here) and from the Pennsylvania Code Chapter 23. Please double-check with your district or other sources, as I’ve seen conflicting information from several sources. This is my current best attempt to get the right answer, but I can’t guarantee that it’s correct. Note that it is possible to claim an exemption to the health/immunization requirements. See What to submit for information on the different options for reporting compliance with these requirements to your school district. 

“Students in home education programs are required to be immunized in accordance with law and regulations of the Secretary of Health. (24 P. S. 13-1303a and 23 Pa. Code 23.83 – 23 Pa. Code 23.84. Students in home education programs are also required to receive the health and medical services required for students of the child's age or grade level.” 

Each child of school age must be given: (Article 14 of the Pennsylvania School Code.)

~ an annual vision test (028 Pa. Code § 23.4. Vision screening tests),

~ a hearing test (028 Pa. Code § 23.5. Hearing screening tests , 028 Pa. Code § 23.6. Threshold hearing tests.) The code cited above, and the PDE's chart of Mandated School Health Services, both state that it is only needed in grades K, 1,2,3,7,and 11.

~ and shall be measured and weighed. (028 Pa. Code § 23.7. Height and weight measurements)

Home education families may use the Department of Health’s form to document the child’s receipt of those services (Department of Health School Health Record). [Note: this form includes way more information than is required, and I don't recommend you use it; see What to submit for other options.]

Each child must also have a medical examination and a comprehensive appraisal of his or her health at the following times. (028 Pa. Code § 23.2. Medical examinations.)

~ When beginning the home school program

~ While enrolled in sixth grade

~ While enrolled in eleventh grade

~ When he/she is issued a farm or domestic service permit

(A medical examination is not necessary at the above points in time if an examination was obtained within the previous four months.)

Also, each child must have a dental examination at the following times. (028 Pa. Code § 23.3. Dental examinations.)

~ When beginning the home school program

~ While enrolled in third grade

~ While enrolled in seventh grade

~ When he/she is issued a farm or domestic service permit”

See here for a chart of the above information.

Immunization requirements:

As mentioned above, students in home education programs are required to be immunized in accordance with law and regulations of the Secretary of Health. (24 P. S. 13-1303a and 23 Pa. Code 23.83 – 23 Pa. Code 23.84.) There are a number of required immunizations; they are listed at 028 Pa. Code § 23.83. Immunization requirements. The list of required immunizations is periodically updated, and many on-line sources (especially lists contained in sample affidavits) are out-of-date. Be sure you have current information! When in doubt, you can call your district or the PDE, or ask your doctor.

The affidavit must contain "evidence that the child has been immunized in accordance with the provisions of section 1303(a)". It is possible to claim an exemption to the immunizations. The PDE interprets the law, specifically the word "evidence", to mean that you must submit a list of immunizations and the date they were received (which can be written by the parent), or an exemption letter from the parent or doctor, with your affidavit. 

If your student has previously attended school in your district, you have probably already submitted immunization information. In this case, if no new immunizations are needed, many people simply put a statement in their affidavit like “Immunization information was submitted at school registration in 2002.” 

Similarly, if you have submitted immunization information with a previous home education affidavit, you may wish to put in your affidavit a statement like “Immunization records were submitted with the home education affidavit for 2002-2003.” rather than re-submitting the information.

Submitting the Information to the School District:

As I mentioned above, there is considerable controversy about the medical requirements. It seems like every one of the 501 school districts handles it differently. I provide here some background information so you can make the decision that is right for your family.

"A notarized affidavit" must be filed with your local school district "prior to the commencement of the home education program and annually thereafter" on or before August 1. The affidavit must include "evidence that the child has been immunized … and has received the health and medical services required for students of the child's age or grade level…". (See The PA Home Ed Law to read these statements in context. If you are interested in looking at the details of the regulations, you may want to read chapter 23 of the Code, at Pennsylvania Code Chapter 23, School Health. 

This 2007 Basic Education Circular from the PDE may also be of interest: K-12 Schools: School Immunization Requirements.) It states, among other things, "The compulsory attendance laws of the Commonwealth do not apply to students excluded from school attendance under the revised Immunization regulations. School officials are without authority under the compulsory attendance laws to initiate legal proceedings against parents whose child is not allowed to attend school because of his or her failure to receive required immunizations. See 24 P.S. §14-1417." See here for a longer discussion of this.

So what do you need to submit with the affidavit? The PDE's position is explained in a letter from the PDE, as quoted below. (A copy of the letter is here – if you agree with the PDE, and you are concerned that your district may not, you may wish to print it out and include it with your affidavit, so that your district is aware of the PDE's opinion.)

"The Pennsylvania Department of Education maintains the opinion that the parent may provide one of the following

1) A form containing results of the physical as conducted by the family's private physician (using the form provided by the Pennsylvania Department of Health for public schools to use for this purpose or any other form desired by the family or physician), or

2) a letter from the medical practitioner indicating the required health and medical services for the child's or children's age and grade per 24 P.S. article XIV have been completed (results of the medical exam are not required), or

3) a letter from the parent indicating religious objections to performance of the required medical services per 24 P.S. 14-1419.

Immunizations must be identified and date received, or an exemption letter from the parent."

To clarify this, here is an e-mail to Michele Hebal from Sarah Pearce of the PDE:

"Dear Mrs. Hebal,
I advise folks that the law requires the affidavit to have attached evidence that the medical services required for the student's age or grade level. [sic] What this may mean is a note signed by your children's doctor saying that the required medical services for the child in whatever grade have been performed. The law does not require you to submit the results of the medical exam, nor have the school district maintain the results of the medical services, although you may have them do that if you wish.
You may submit your objection to the immunization per 24 P.S. Sec. 13-1303-a(c) and (d) with your affidavit. See: http://www.pde.state.pa.us/home_education/cwp/view.asp?a=148&Q=56276#IMM
Please feel free to contact me if you have additional questions or concerns.
Sincerely,
Sarah J. Pearce Advisor School Services Unit
Pennsylvania Department of Education 333 Market Street Harrisburg, PA 17126
Telephone: 717/783-9287 E-mail: spearce@state.pa.us"

Despite the PDE’s opinion, some homeschoolers keep the medical records on file, either in their home or at their physician's office, and do not submit medical forms yearly to the district. In that case, they usually put wording indicating this in their affidavit. Some districts accept this; others do not. Here are two examples of such wording:

"I attest that the children have received immunization in accordance with the provisions of section 1303(a) and have received the health and medical service required for students of the child’s age in Article XIV and that these records are being maintained; or I have supplied a medical, religious, or ethical exemption; and this notarized affidavit shall be satisfactory evidence thereof."

"Medical records are on file with the family physician." and "Immunization records were submitted previously upon notification of home education program in 19--."

If you are withdrawing your child from public school mid-year, you may wish to use a statement like:

"I attest that the child has received immunization in accordance with the provisions of section 1303(a) and has received the health and medical service required for students of the child’s age in Article XIV, and that medical information was submitted to [name of school] while the student was enrolled there from [month/year of entrance] to [month/year of withdrawal]."

Some families feel that their statement in the affidavit that the medical requirements have been met should be sufficient. Here is a great letter written by a homeschooler to her district on this point. (I have altered it slightly to remove identifying info.) They accepted her interpretation of the law. 

Re: evidence of immunization for [student’s name]

Dear [assistant superintendent],

Last week I received a call from [the secretary] in your office inquiring about my daughter’s immunizations. [The secretary] was of the opinion that we need to send you a copy of her immunization records.

However, if you look at Act 169, it states that “A notarized affidavit of the parent or guardian or other person having legal custody of the child or children, filed prior to the commencement of the home education program and annually thereafter on August 1 with the superintendent of the school district of residence and which sets forth: the name or the supervisor of the home education program ...; evidence that the child has been immunized in accordance with the provisions of section 1303 (a) and has received the health and medical services required for students or the child’s age or grade level in Article XIV; and that the home education program shall comply with the provisions of this section and that the notarized affidavit shall be satisfactory evidence thereof.” (underlining mine) I understand that those who framed this part of the law did not intend that parents be required to send any medical, dental or immunization records to the school district. The notarized affidavit itself, in which the parent attests that these services have been provided, is the only evidence needed. Please note that this affidavit also provides evidence of all other required health services.

If you look at the affidavit I sent you last summer for [my children], you will note that it states: “I also attest that I have a high school diploma, that each child in the home education program is receiving the health and medical services required by Article XIV, that each child has been immunized in accordance with the provisions of section 1303(A) and that a comprehensive health record is being maintained for each child.” This is the evidence of immunizations that you need.

I hope that this will resolve the matter to your satisfaction.

Sincerely,

[homeschool mom]

Medical and Dental Report Forms:

Some school districts ask that you submit detailed medical information with your affidavit. As discussed above, the PDE says this is not necessary. (If your district is asking for more than the PDE feels is required, contact the PDE for help.) The PDE says that one way to report that the medical requirements have been met is to submit a letter from the medical practitioner saying the requirements have been met. Below are some handy-dandy forms that may be useful if you choose to go this route. (Please read this whole page before deciding how you will handle the medical requirements, and if these forms are the best approach for you.) Your school district may also provide you with forms – carefully consider whether their forms comply with the PDE’s opinion about what you need to submit before using them. The state's forms are all available from the Department of Health.

~ Medical Services Report Form:
A simple form, to report that a child has received the medical services indicated (vision, height and weight, hearing, medical exam, scoliosis exam, tuberculosis test) is available at medicalservicesreport.doc (in .doc for MSWord) or medicalservicesreport.pdf (in .pdf for Adobe Acrobat). The form is to be signed by the medical services provider. 

~ The public schools use either the Department of Health's School Health Record or the Private Physician’s Report of Physical Examination of a Pupil of School Age (available here or here or here). Some districts hand these out to home educators, but I do not recommend you use either of these. Remember that the PDE says you only need "a note signed by your children's doctor saying that the required medical services for the child in whatever grade have been performed. The law does not require you to submit the results of the medical exam..." If your district is insisting that you use this form or something similar, call the PDE for help.

~ Dental Services Report Form:
A simple form to report that your child has received dental services is available at dentalreport.doc (in .doc for MSWord) or dentalreport.pdf (in .pdf for Adobe Acrobat). Have your dental care provider sign this form as evidence of the dental exams required by the PA home education law.

~ The public schools use either the Department of Health's School Dental Record or the Private Dentist's Report of Dental Examination fo a Pupil of School Age (available here or here or here).  Again, I do not recommend you use either of these.

Claiming an Exemption:

There are several different kinds of exemptions to the medical requirements. I suggest you read the law and code regarding exemptions before declaring one. (See links below.) 

~ Children need not be immunized if a physician or the physician’s designee provides a written statement that immunization may be detrimental to the health of the child. See 028 Pa. Code § 23.84. Exemption from immunization and 24 PS 13-1303a Immunization required; penalty

~ Children need not be immunized if the parent, guardian or emancipated child objects in writing to the immunization on religious grounds or on the basis of a strong moral or ethical conviction similar to a religious belief. See 028 Pa. Code § 23.84. Exemption from immunization and 24 PS 13-1303a Immunization required; penalty.

~ Children may be excused from medical or dental examinations on presentation of written evidence to the school administrator that the examinations are contrary to the religious beliefs of the parent or guardian of the child. See 028 Pa. Code § 23.45. Objections to examination on religious grounds. and 24 PS 1419 Objections to examination or treatment on religious grounds. Note that, unlike immunizations, this does not include moral or ethical beliefs.

Parents who do not immunize, or who selectively immunize, may also wish to read this 2007 Basic Education Circular. Apparantly, under certain circumstances, "The compulsory attendance laws of the Commonwealth do not apply to students excluded from school attendance under the revised Immunization regulations. School officials are without authority under the compulsory attendance laws to initiate legal proceedings against parents whose child is not allowed to attend school because of his or her failure to receive required immunizations. See 24 P.S. §14-1417." Please read the entire BEC, and consider seeking legal (and perhaps medical) council, if you wish to persue an exemption to the compulsory attendance law based on this information. See here for a longer discussion of this.

Exemption Forms:

Please read the Code above to decide which kind of exemption fits your situation.

~ A simple form for declaring a parent's religious, moral, or ethical objection to immunizations, medical exams, and/or dental exams is available at medicalexemptionform.doc (in .doc for MSWord) or medicalexemptionform.pdf (in .pdf for Adobe Acrobat). 

~ PHEN's Medical Exemption Forms from The Pennsylvania Home Education Network are for declaring a religious, moral, or ethical objection to immunizations, medical exams, and/or dental exams.

~ NHCH's Medical Exemption Letter from North Hills Christian Homeschoolers states an objection to submitting medical and dental examination records on religious, moral, or ethical grounds. This does not exactly match the regulations in the Code, but has been used by some families. (Note that your district should NOT be asking you for records beyond the names and dates of immunizations and a statement from your doctor/dentist stating that the required services were given.)

If you are claiming a medical exemption to immunizations (as opposed to a religious, moral, or ethical objection), the PDE believes you must use a statement from your physician stating that immunization may be detrimental to the health of the child. Sorry, I don’t have a form for that!