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District
Schools
Cantiague Elementary School
George A. Jackson Elementary School
Jeffrey Ratner Robert Seaman Elementary School
Jericho High School
Jericho Middle School
Jericho Union Free School District
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Health Office Forms
Medical Home Instruction
Medical Home Instruction Form
If your child will be out of school for an extended period of time (for 14 days or more) due to a non-communicable illness or recovering from an injury, please have your healthcare provider fill out the Medical Home Instruction Form. Please make sure the form is fully completed and is signed and stamped by the healthcare provider. The form will be reviewed by the school physician and is subject to approval.
Please return or
E-mail
completed form to the school nurse.
Form Instructions for Printing
