Health Services

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Northwest Region 7 School District Health Services

Dorothy Mitchell, RN  
Patricia Severson, RN

Phone: 860.379.8525, ext. 2618 or   ext. 2619
FAX : 860.379.8940

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 or religious 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


Students must register for sports tryouts using Family ID a minimum of TWO WEEKS BEFORE THE TRYOUT DATES.

Anyone who is not registered at least two weeks before the tryouts is not immediately 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:

  1.  A physical that is less than 13 months old on file in the Nurses Office
  2.  No current physician-imposed restrictions from previous injuries or conditions
  3.  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 with the Athletic Trainer. 

You may use Family ID 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. 


Emergency Health Form Form A Front-Back. pdf

To be completed at the start of each academic year and also when health status, address, or emergency contact numbers change.

CT Health Assessment Record* .pdf

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.  Needed for entry into Grade 6, 10, and sports participation.

Medication Authorization Form 2018-19.pdf

Any medication to be taken in school, on field trips and during extracurricular sports activities must have this form filled out and signed by MD and parent every academic year.

Asthma Action Plan and Medication Authorization pdf.pdf

For students with asthma and inhaler usage

 Emergency Allergy Medication  Authorization . pdf

To be completed by the physician each year.

Standing Order Tylenol Ibuprofen Parent Permission Form 18-19.pdf

This form allows the nurse to administer Tylenol, Ibuprofen and TUMS  with only the parent signature.  All other medications must have written Medical authorization from the physician.


Medical_Exemption From_Immunization. pdf

For students who are not immunized due to medical reasons.

 Religious_Exemption_ From Immunization .pdf

For students who are not immunized due to religious beliefs.  

Husky Insurance . pdf

Explanation of insurance access for those without insurance