Clinic

Commonwealth Of Virginia, School Entrance Health Form
School Health Entrance Form (Revised 2010) Instructions
Permission for Emergency Care
Allergy Action Plan
Epinephrine Authorization Form
Asthma Action Plan
Inhaler Authorization Form
Medication Authorization Form (Not For Epinepherine, Inhaler or Antihistamine Authorization)
Pandemic Flu Plan

Dear New and Returning Parents,

It has been a pleasure serving you and your children as School Nurse this past year. I look forward to meeting and working with our new families as the 2011-2012 school year begins. To provide for the health and safety of all of the children, I am asking that each family provide me with important health information prior to the start of school.

1. If your child is new to Nativity School you must turn in a Commonwealth Of Virginia, School Entrance Health Form signed by your physician before the first day of school. Your doctor will verify that all immunizations are up to date.

2. All new and returning parents: if your child has a medical condition that requires special monitoring or medication while at school I ask that you notify me prior to the start of school so that we can be sure the proper medication authorizations, medicines and Care Plans (see links above for forms) are in place before the first day of school. This includes Epi-pens and Benedryl for allergies, seizure medication, Albuterol Inhalers, insulin and any other emergency medication.

3. If there are any new medical conditions or changes in established conditions that need to be noted please contact me prior to the start of school. This includes an updated food allergy list.

4. All students entering 6th grade in August must have documentation of a Td (tetanus/diphtheria booster) within the last 5 years. (Sometimes listed as ADACEL). If you child receives any other immunizations, please send a copy of those also.

I appreciate your cooperation in allowing me to provide the highest quality care for your children starting the moment they walk through the door. I will be available starting Monday August 22nd, 2011 to receive medications and answer questions. If you need to contact me to discuss your child's health care needs prior to August please leave a message with the school office and I will return your call. The school office will be open 8:30 am to 12:30 pm Monday through Thursday through most of the summer.

Remember to take the appropriate Medication Administration Authorization forms with you as well to the doctors will save you time and inconvenience (see links above). All forms with instructions are available in the school handbook.

My clinic phone is (703)-455-2300 ext. 122. Have a healthy and safe summer.

Colleen Jarvis R.N.