Medical Forms | School Nurse
Northwest Region 7 School District Health Services
Dorothy Mitchell, RN
Amanda D'Urso, RN
Phone: 860.379.8525, ext. 2618 or ext. 2619
FAX : 860.379.8940
Dear Families and Students,
We would like to wish you all a happy and safe summer! Please watch for your 2023-2024 health forms in the mail from the MS and HS offices. These forms should be brought in on the first day of school to better serve and know your students. Please see the link above regarding our “Health Services Information”, as it may answer many of your questions.
As of this writing, Covid-19 guidelines have not changed in regards to the timing of return to activity when a student contracts the virus. This fall, the health office still expects to be reporting Covid-19 cases to the Health Department, so please continue to notify us if your student tests positive.
Lastly, please remember to keep the health office in the loop when your student falls ill, has an injury, or has a change/or starts a new medication. The health office is here to arrange health accommodations as needed.
August 28th is the first day back for the Health Office. Calls and emails will be returned at that time.
Dorothy Mitchell, RN
Amanda D’Urso, RN
District Enrollment Requirements: Health Office
In accordance with BOE policy students entering school must present at the time of registration proof of age, evidence of legal residence and must meet the State requirements for immunization & health assessment.
At the time of registration parent/guardian must present proof of adequate immunization. If the child is exempt from immunizations due to a medical reason, the parent/guardian must provide a notarized State of CT Exemption form.
Students enrolling in grade 6 or 10, or those students enrolling from out of state must have a current health assessment (State of Ct Health Assessment Record) on file. 10th graders must present the form before the end of their 10 grade year.
Parent/ guardian must complete the Pink Student Health Emergency Information Form.
If the student has any medical concerns the parent/guardian should speak with the Health Office staff to ensure proper planning has occurred prior to their start of school
IMPORTANT INFO RE: SPORTS REGISTRATION
Students must register for sports tryouts using Family ID/Arbiter Sports.
Anyone who is not registered by these dates is not guaranteed the required approval to participate in tryouts. Once registration has been entered into Family ID, the nurses then begin the approval process by certifying that the following are on file in the Nurses Office:
Sports registrants must have:
- A physical that is less than 13 months old on file in the Nurses Office
- No current physician-imposed restrictions from previous injuries or conditions
- Those with history of concussion must have on file in the Nurses Office a physician note clearing the concussion, and have completed the return to play protocol.
You may use Family ID/Arbiter Sports at any time to check for when your physical expires. You will also get an email from Family ID site 60 days in advance of the expiration date of your physical.
To be completed every year and/or when details change
Used for mandatory physicals in 6th, and 10th grades as well as new enrollments to the district. This form must be on file in the health office and updated every 13 months for sports participation.
Every student who requires any medication in school, on field trips or athletic events must have this form completed by MD every year. Students may carry their own Epi pens, inhalers and diabetes supplies BUT there must be a signed MD order on file in health office for the medications.
This form allows the nurse to administer Tylenol, Ibuprofen and TUMS with the parent /guardian signature. All other medications must have written medical authorization from the physician.
For students with asthma and inhaler usage
To be completed by the physician each year.
For students who are not immunized due to medical reasons.
Explanation of insurance access for those without insurance