Clementon Elementary Nurse

Nurse

The Clementon School Nurse works as part of an education team to promote the overall health and well-being of all students and staff that make up the Clementon School District. A wide range of health services are provided. These services include:

Developing emergency care plans for students with life-threatening health conditions such as severe allergies to peanuts or bee stings, severe asthma or diabetic students with insulin reactions.
Administering medications to students and care for ill or injured students in the school setting.
Completing health assessments for students being evaluated to receive special education services. Providing state-mandated screenings and referrals for health conditions such as vision or hearing.
Monitoring any possible communicable disease outbreaks in the school setting.
Serving as a liaison between the school, the home, and medical or other community resources.
Providing health education to students.
Promoting a healthy school environment.

General INFORMATION AND FORMS
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All forms must be renewed every school year.
Please make sure that all forms are signed by the physician and yourself prior to bringing them into school.
Keep the nurse informed of any changes to your child's health.

Health Information Sheet for Parents

Yearly Medical Update Form

Asthma/Inhaler Use:

Your child’s physician must complete and sign the Asthma Treatment Plan. Parents/Guardian must sign the bottom of the Asthma Treatment Plan.
Inhalers/NEB solutions must be in the prescription labeled box and hand delivered to the school nurse by the parent or guardian.
Children are not permitted to carry medications!

Asthma Treatment Plan

Epi Pen Use:

Your child’s physician must complete and sign the Anaphylaxis Emergency Care Plan.
The Parent/Guardian must sign the bottom of the Anaphylaxis Emergency Care Plan (remember to indicate on the bottom of the form if you wish for your child to sit at a peanut/nut free table at lunch).
Epi Pens must be in the prescription labeled box and hand delivered to the school nurse by the parent/guardian.

Anaphylaxis Emergency Care Plan

EpiPen Administration Form

Medication Administration:

Your child’s physician must complete and sign the Medication Authorization Form.
The parent/guardian must sign the bottom of the Medication Authorization Form.
All medications (prescription or non-prescription) must be in its original container and properly identified and hand delivered to the school nurse by the parent/guardian.
Medication Dispensing Form

ATHLETIC FORMS
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All forms listed below must be completed in their entirity in order for student to participate in any sport at Clementon Elementary School. Forms must be completed and submitted to the school nurse every year.

Annual Athletic Pre-Participation Physical Examination Form
Health History for Athletic Participation
Concussion and Head Injury Fact Sheet
Sudden Cardiac Death in Young Atheltes (sign off sheet)

Clementon Elementary School

Nurse

General INFORMATION AND FORMSTop of Page

ATHLETIC FORMSTop of Page

Clementon Elementary School

General INFORMATION AND FORMS
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ATHLETIC FORMS
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