2016 – 2017 Medical Forms

Below are the links to download the medical forms for the 2016-2017 school year. Kindly have the forms filled out completely and signed by both the your child’s physician and yourself prior to submitting to nurse.

  1. Medication Administration to Students Letter (everyone must read)
  2. Permission to Share Information Form
  3. Medication Request Form (needed for all prescription and non-prescription medications)
  4. History and Physical Forms Gr 5-8 Students
  5. Health Update Form
  6. Physician/Parent Certification For Student’s Self-Administration
  7. Food Allergy & Anaphylaxis Emergency Care Plan (FARE)
  8. Food Allergy Physician/Parent Authorization (Must be handed in with FARE)
  9. Asthma Treatment Plan
  10. Annual Athletic Pre-Participation Physical Exam Forms Gr. 5-8 (Sports)
  11. Health History Update Questionnaire
  12. Sudden Cardiac Death Pamphlet
  13. Sudden Cardiac Death Sign Off Form
  14. Concussion Sports Sign Off Form

Health Requirements

All new students:
History and Physical Exam Completed within 1 year prior to admission. Students Grades preK-4 use  physical form given at time of registration;  GR 5-8, please use form #4 above for physical.

Pre K students:
Completed Holy Spirit History and Physical Exam Forms , Immunization Record at time of enrollment. Flu Shot  administered between September 1 and December 31 of school year once completed.

Incoming Kindergarten students:
Copy of 5 year old physical and additional required vaccines.  Usually includes 2nd MMR and additional doses of both the OPV and DTaP vaccines since Pre-K enrollment.

Incoming Sixth grade students:
Copy of Tdap and meningococcal vaccines.  Copy of 11 year old physical not required but appreciated.

Fifth to Eighth Grade Sport Participants (Cheerleading and Basketball):
Annual Athletic Pre-Participation Forms pages 1, 2 and 4 completed and signed by both parents and health care provider.  Date of Physical Exam must be within one year of start of tryouts.  If physical performed more than 90 days prior to tryouts, students must also submit “Health History Update Questionnsire” completed and signed by parent.  All of these forms are available below or from the nurse’s or main office.

Food Allergy Policy 2016-2017- For All Parents:
There are approximately 20 children in our school with documented allergies to peanuts and/or nuts. Accidental ingestion (or in 2 cases, touching) these foods can result in reactions ranging from hives to difficulty breathing or even death. For this reason, no peanut butter or snacks containing peanuts or nuts are allowed in the classroom (ie. snack or latchkey). Peanut butter is still a lunch option, although students eating peanut butter will now eat with a friend at a designated “peanut butter” table.  After washing his or her hands, the student can return to the class table if desired.  Staff/Parent volunteers will assist with monitoring the new procedure.  This is a means of ensuring and respecting the safety of others.

If you are sending in a birthday treat, please include an ingredient label with the food item. The food item should be left in the main office so that the ingredients can be reviewed before it is distributed at snack time. In the event that ingredients are unknown, parents of students with allergies are asked to provide an alternative safe food for the homeroom teacher to have on hand for their child.  We thank you for your anticipated cooperation in keeping all of our children safe.

Guidelines for the School Year
The following guidelines will assist you in keeping all of our children both healthy and safe this year.

Good attendance is valued by all of us, and we hope that this school year is a healthy one for our children. There are some occasions, however, when children need to stay home from school. Here are some guidelines that are designed to protect the health and safety of all of our children and staff members.

  1. If a child has or is sent home with a fever, he or she is expected to stay home fever free without the use of Tylenol or Motrin for a full 24 hours before returning to school.
  2. If a child vomits during the night or in the morning, please do not send him or her to school. If a child vomits in school, you will be called to pick him or her up.
  3. If a child has been diagnosed with strep throat, state law requires he/she must be on antibiotics for a full 24 hours before returning to school. Kindly send in a note from your child’s MD, APN, or minute clinic so that it can be included in your child’s health record and so that we can keep track of any illness that is amongst our school population.
  4. A child with conjunctivitis (pink eye) must also be on medication for 24 hours before returning to school.
  5. It is very important that the school nurse is notified if head lice or nits(eggs) are found in your child’s hair. As with all health issues, confidentiality will be maintained as your child’s wellbeing is monitored.
  6. If a child needs to be excused from physical education, a note from the parent/guardian or primary care provider is required.
  7. Parents need to notify the nurse if the child is on crutches, has a cast, or is in a brace of any kind.
  8. No medications, including over the counter medications, will be administered to students unless there is a completed medication request form signed by the student’s parent and health care provider. Medication must be in the original prescription bottle or original unopened container.
  9. Parents must call absences in to the office, and a parent note with reason for absence is expected upon the child’s return to school. If you have taken your child for medical evaluation or treatment, also include a copy of MD note as to diagnosis and any school follow up or restrictions that we should know of.

Thank you for ensuring the well being of our school. Feel free to call or email with any questions or concerns.

Mrs. Jilda Sidebottom, R.N.
School Nurse