Franklin County Technical School   82 Industrial Blvd.   Turners Falls, MA 413 . 863 . 9561

School Nurse Forms

General Health Forms (click to view)

Med Permission Form

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Consent to Administer Meds

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Physical Exam Form

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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 Immunization

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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)

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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 Plan

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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 Plan

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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 Plan

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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.

Kelly Doyle, BS, MBA, RN - FCTS School Nurse

Kelly Doyle is the FCTS School Nurse. Click to email Kelly. Phone: 413-863-9561, extension 126. Kelly is often very busy with students and not near her phone. If you call and do not get an answer, please leave a message with your name, contact number, reason for your call and the student you are calling about. She will return your call.

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