BF School Nurse

Health Forms

  • Physical Form (Universal Child Health Record)

    by

    The Board of Education requires all students new to the District to have a physical examination. The Universal Child Health Record form is to be completed by your child's physician. Physical examinations must be done no more than 365 days prior to school entry to be accepted for registration. Please make sure the date of the physical exam is specified by your physician.

    01-Universal Child Health Record.pdf 34.67 KB (Last Modified on February 26, 2016)
    Comments (-1)
  • Immunization Requirements

    by

    This is a list of immunizations required for all students to attend school in New Jersey. Immunization records need to be submitted to the Health Office for review BEFORE your child can start school.

    02-Immunization Requirements.pdf 29.86 KB (Last Modified on February 26, 2016)
    Comments (-1)
  • Request for Administration of Medication

    by

    This form must be completed by the physician for daily medications including over-the-counter or short term medications, such as antibiotics and cough medicine.

    03-Request for Administration of Medication in School.pdf 112.08 KB (Last Modified on February 26, 2016)
    Comments (-1)
  • Policy Regarding the Administration of Medication in School

    by

    Reviews policy & procedures when medication is required in school, on field trips or at school-sponsored events.

    04-Administration of Medication in School.pdf 89.42 KB (Last Modified on February 26, 2016)
    Comments (-1)
  • Health Services Agencies

    by

    For residents of Mercer County who are in need of receiving medical care, but do not have adequate health insurance, the attached list of agencies may be able to provide care at a reduced fee or no cost.

    05-Health Services Agencies.pdf 20.22 KB (Last Modified on February 26, 2016)
    Comments (-1)
  • 24 Hour Rule

    by

    In an effort to keep germs out of school, the District asks that you follow the "24 Hour Rule". Please read the attachment describing the exclusion time from school for the most common communicable diseases. Please call the Health Office if your child is diagnosed with a communicable disease. The nurse keeps a record so that they can monitor the number of cases of a particular disease and they send home notices to alert parents.

    06-Exclusion from School - 24 Hour Rule.pdf 156.10 KB (Last Modified on February 26, 2016)
    Comments (-1)
  • Flu Information

    by

    The attachment reviews key facts about the flu. This information may be helpful. For more detailed information, you can visit the Center for Disease Control (www.cdc.gov) or the American Academy of Pediatrics (www.aap.org) web sites or contact your physician.

    07-Information About the Flu.pdf 956.81 KB (Last Modified on February 26, 2016)
    Comments (-1)
  • Allergic Reaction Action Plan

    by

    This form is to be completed by the healthcare provider when a student requires emergency medication for an allergic reaction.

    08-Allergic Reaction Action Plan.pdf 118.31 KB (Last Modified on February 26, 2016)
    Comments (-1)
  • Allergic Reaction - Parent Authorization

    by

    This form is to be completed by the parent/guardian indicating whether or not the student is capable of self-administering emergency medication. This form also has a section for parents/guardians to authorize a trained designee to administer emergency medication in the absence of the school nurse.

    Comments (-1)
  • Allergic Reaction - Parent Contact Information

    by

    This form is to be completed by the parent/guardian giving current emergency contact information This form also has a section for parents/guardians to authorize emergency medical treatment for their child.

    10-Allergic Reaction-Parent Contact Info.pdf 11.71 KB (Last Modified on February 26, 2016)
    Comments (-1)
  • Asthma Action Plan

    by

    This form is to be completed by the healthcare provider. There is a section at the bottom where the healthcare provider must indicate whether or not the student is capable of self-administering his/her asthma medication in the absence of the school nurse.

    11-Asthma Treatment Plan - Student.pdf 1.99 MB (Last Modified on February 26, 2016)
    Comments (-1)
CLOSE