MEH-23 - The School District of Philadelphia - philasd 2026

1. Click ‘Get Form’ to open the MEH-23 document in the editor.
2. Begin by entering the student’s name, birth date, PID#, school name, grade, room number, and school nurse's contact information in the designated fields.
3. Instruct your physician to complete the section labeled 'COMPLETED BY CARE PROVIDER', including the diagnosis and degree of activity permitted. They should check the appropriate boxes for activity levels and any restrictions.
4. Ensure that your care provider adds their signature, telephone number, address, and date signed at the bottom of the form. A care provider office stamp is also required.
5. Review all entered information for accuracy before saving or printing the completed form to submit it to the school nurse.

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