Health Office

 Rebecca Lassen

 Sylwia Straub

 Patricia Mader-Karan

 Renee Mowczan

 Roxanne Graham

 Universal Child Health
 Record Form

New Jersey Administrative Code 6A:16-2.2 (2001) requires students to receive a medical examination upon school entry and recommends at least one time during each developmental stage (early childhood, pre-adolescence, adolescence). Upon enrollment into school, the school district requires parents to provide examination documentation of each student within 30 days upon initial enrollment into a New Jersey school. Students transferring into a New Jersey school from out-of-State or out-of-country may be allowed a 30-day period in order to obtain entry examination documentation.

 K-12 Immunization

State of NJ Immunization Requirements for Public Schools
 

 Health History Form

Each student is required to have a medical health history completed by a parent including allergies, past serious illnesses, injuries and operations, medications and current health problems.

 NJ State Physical
 Athletic Form

New Jersey Administrative Code 6A:16-2.1 states that:
Each school district shall ensure that students receive medical examinations:

• Prior to participation on a school-sponsored interscholastic or intramural athletic team or squad for students enrolled in any of grades 6 to 12
• The examination shall be conducted within 365 days prior to the first practice session
• The medical examination shall include a health history questionnaire completed and signed by a parent
• The report of health findings of the medical examination for participation shall be documented on the Athletic Preparticipation Physical Form

 Parental Request for
 Nurse to Administer
 Medication in School

Pupils requiring any medication at school must have a written statement from the family physician, which identifies the diagnosis, the medication, the dosage, the time(s) for administration, and, the number of days on which the medication is to be administered.  This applies to both prescription and over-the-counter medications.

New Jersey Administrative Code 18A:40-12.3 requires each student authorized to use asthma medication (inhaler or nebulizer treatment) shall have an Asthma Action or Treatment Plan prepared by the student's medical home and submitted to the school nurse.

 Self-Administration of
 Medication Form

New Jersey Administrative Code 18A:40-12.3 (2001) permits the self-administration of asthma medication by a student for asthma or another potentially life-threatening illness, provided that written authorization for self-administration of medication and written certification of the student's ability to self-administer from the parent is given, and written notification of the district's exemption from liability resulting from injury is given to and signed by the parents.

New Jersey Administrative Code 18A:40-12.3 requires each student authorized to use asthma medication (inhaler or nebulizer treatment) shall have an Asthma Action or Treatment Plan prepared by the student's medical home and submitted to the school nurse.

 Parental Authorization of
 Emergency
 Administration
 of Epinephrine

Procedures specified in the “Protocol and Implementation for the Emergency Administration of Epinephrine by the Delegate Trained by the School Nurse” require a description of allergic reaction and treatment, as well as parental authorization for administration of medication by nurse or delegate and hold harmless documentation.

 Request for Self-
 Administration of
 Medication Form

New Jersey Administrative Code 18A:40-12.3 (2001) permits the self-administration of medication by a student for a potentially life-threatening illness, provided that written authorization for self-administration of medication and written certification of the student's ability to self-administer from the parent is given, and written notification of the district's exemption from liability resulting from injury is given to and signed by the parents.

 Report of Dental
 Examination Form

It is important for children to have periodic examinations by a dentist.  In order to document annual dental check-ups in the student health records, it is requested that family dentists complete the form reporting dental examinations each school year and submit completed forms to the school health office.