October 2, 2017
Health Forms
September, 2017
Dear Parents: It is well known that good physical health is vital to your child’s academic success. Attached please find the following forms that you will need to complete and return to the Health Office no later than October 10th for the 2017-2018 school year if you have not already done so. We have received some forms but are still missing quite a few. Please click on the form name to view/print.

1.      Health Appraisal Form: To be completed by your child’s physician/practitioner after a physical examination. * Please note that a physical exam form is required by law for all new entrants, and students in Grades K, 2,4,7,9 and 11. A physical examination completed anytime on or after September 1, 2016 is acceptable.


2.      Immunization Certificate: All immunization information must be documented. The complete listing of required immunizations according to grade level is attached. Your child’s immunization record is acceptable in a variety of formats. Please note that some immunization requirements for 2017-2018 may have changed. We urge you to review your child’s immunization record with your pediatrician to ensure that your child is properly immunized to attend school this school year. All students MUST have proper documentation of the required vaccines in order to remain in school.


3.      Medical History: To be completed by parents/guardians on all new students, in an effort to meet all of your child’s health care needs. Please feel free to contact the school nurse if you would prefer to schedule an appointment to review your child’s Health History.


4.      Dental Examination Certificate: Recommended for all students.


5.      Residency Form: Required if you reside in any of the five boroughs of New York City. The completed and signed original form must be returned no later than October 30th. Please attach a utility bill to this form to show proof of residency.


6.      Medication Administration Form: To be completed by your child’s physician, and you, if your child will be taking any medication while he or she is at school this year.

l  Please note that all medications (including over-the-counter and inhalers) must have a physician’s order and signature or we cannot administer them in school.
l  If your child has Asthma, it is a good idea to keep an extra inhaler at the nurse’s office. If your child has an isolated attack, I will then be able to help him/her. Please complete these forms and return to the Health Office as soon as possible, but no later than Tuesday, October 10th. Students are not permitted to remain in attendance without the necessary health documentation. This is a New York State Law.
l  Self-Carry Form – If you and your physician feel that your child is old enough and mature enough to self-carry their own medication you must have a separate form completed (also attached).
l  Allergy Action Plan – If your child has a food or bee allergy you must also have your physician complete an Allergy Action Plan (AAP). Please send in emergency medications with the doctor’s order that your child may require in an emergency allergic response situation. This may include any and all Epi-pens and/or Benadryl. These medications will be kept with the secretary when I am not here for easy access should a child need it. We have staff specifically trained to provide the Epi-pen in an emergency.
If you have any questions, please email me at  jrosenbluth@nredlearn.org.
Thank you for your cooperation. Best wishes to you and your family and welcome back to a great school year!
Julie Rosenbluth, RN School Nurse