General Health Forms (click to view)
Med Permission Formclick to view
Consent to Administer Medsclick to view
Physical Exam Formclick to view
Print off this form and take with you each time your child has a physical examination. Instruct your child to bring a copy to the Nurses' Office so we can keep it on file.
Certificate of Immunizationclick to view
Please have your Health Care Provider complete this form when new/booster immunizations are made. Instruct your child to bring a copy to the Nurses' Office so we can keep it on file.
Life-Threatening Allergy Action Plan (food, insects, etc)click to view
Life-Threatening Allergy Action Plan for students with anaphylaxis (potentially life-threatening allergies). Please print off a copy to take to your child's medical provider and then return to the school nurse as soon as possible. We recommend that you remind your child to carry their epipen on his/her person at all times. This Action Plan needs to be renewed every school year. Please call the School Nurse with any questions or concerns.
Diabetes Medical Management Planclick to view
The Diabetes Medical Management Plan (DMMP) is for students who have been diagnosed with diabetes. Please print out a copy for the doctor to fill out, sign it, and return to the school nurse as soon as possible. A renewed DMMP is required to be turned in at the start of every school year.
Seizure Action Planclick to view
The Seizure Action Plan is for students who are being treated for a seizure disorder. Please have the student's health care provider fill out the action plan. In addition to the health care provider's signature, the action plan will also need to be signed by the student's parent/guardian.
Mass. Asthma Action Planclick to view
The Asthma Action Plan (AAP) is for students who may need to use their inhaler in school. Please print out a copy for the doctor to fill out, sign it, and return to the school nurse as soon as possible. Please discuss with the doctor and your child the importance of having their rescue inhaler available at all times. A renewed AAP should be turned in at the start of every school year.