• Please click on the appropriate form that pertains to your needs.  If your child has a medical condition, and you do not see a form that you may need, or have any questions, please contact Ms. Chapman. 

     

    Medications should be given before or after school by a parent or guardian, however there are some instances where medication must be given during school hours.  If your child must have medication given during school hours, please call Ms. Chapman.  There are forms that need to be completed by the doctor, and the medication needs to be in the original box/bottle with the label from the pharmacy affixed.  

     

    Permission to Administer Medicine (Permiso para medicar)

    • This form must be filled out by both the parent and the doctor.  It is REQUIRED to be filled out if the school nurse is to give your child ANY medication (even Tylenol or other over the counter medicines).  This form needs to be completed for each school year. 
    • Este form DEBE ser llenado tanto por el padre como por el medico.  Es NECESARIO completarlo si la enfermera de la escuela le va a dar a su hijo CUALQUIER medicamento (incluso Tylenol u otros medicamentos de venta libre). Este formulario debe completarse cada ano escolar. 

     

    Asthma Action Plan  (Plan de accion contra el asma)

    • The above Asthma Action Plan meets NJ Law N.J.S.A. 18A:40-12.8
    • Every child who will be using an inhaler or nebulizer in a New Jersey school is required to have a completed Asthma Action Plan on file in the nurse's office.
    • Be sure that the Asthma Action Plan is complete prior to bringing the form to the nurse’s office. (Areas often missed are triggers, parent signature, provider stamp and the box where you check if a student can self-administer.)
    • If I do not have a completed Asthma Action Plan AND the medication, I am very limited in what I can do to help your child if they have an asthma attack. 
    • Medication will not be accepted without the proper completion of paperwork.  

     

    Anaphylaxis Action Plan / Plan de acción contra la anafilaxia

    • Please make sure that all areas of the action plan are completed.
    • Every child who has allergies requiring medication in a New Jersey school is required to have a completed Anaphylaxis Action Plan on file in the nurses office.
    • It is extremely important to let the school nurse and his/her teacher know of any and all allergies your child has.
    • Medication will not be accepted without the proper completion of paperwork.  

     

    Seizure Action PlanPlan de accon para las convulsiones

    • This form is to be used if your child has been diagnosed with a seizure disorder.
    • Please be sure to have the paperwork completed along with the medication. 
    • Please call the school nurse to discuss the type of seizures your child has and how they present. 

     

    Universal Health Record/Physical Exam

    • This form is to be filled out by the pediatrician when your child needs to have a physical exam.