Nurses’ Office

Forms + Checklist

Child and Adolescent Health and Examination Form
The Child and Adolescent Health and Examination Form is to be completed by your child’s NYS medical practitioner. It is required for school entry for the following students:

• All new students
• All preschool and kindergarten students
• All returning 1st, 6th, 9th, and 12th grade students
• All students who plan to play team sports

As soon as your child has their next annual well-visit, please upload a copy to the August Schools Health portal. All preschool students are required to receive a yearly flu vaccine by December 15.

Annual Over-the-Counter (OTC) Medication Form

OTC Medication Form to be completed and signed by both parent/guardian and pediatrician.

Action Plans for Students with Severe Allergies/Anaphylaxis, Asthma, Seizures, or Diabetes
If your child may require medication during school for severe allergic reaction/anaphylaxis, asthma, seizures, or diabetes, your pediatrician must complete an action plan.

• Anaphylaxis/Allergy action plan for students with severe allergies/anaphylaxis
• Asthma action plan for students requiring an inhaler in school
• Seizure action plan for students with rescue meds
• For Diabetes forms, please contact nurses@saintannsny.org or your child’s endocrinologist.

Sports Team Forms in 6th–12th Grade

All children participating in a team sport are required to have a current physical on file (dated within the year of the first day of practice). Additionally, all 7th–12th-grade parents/guardians need to complete an interval health history form, which will be made available at the start of each sports season. 6th graders do NOT need an interval health history form.

Your child’s coach will be in touch regarding missing forms at the start of each sports season.

Click here to access the August health platform to upload forms.

In accordance with New York State Public Health Law (not the CDC), all students must be immunized. Proof of vaccination or immunity from the following is required for all students: measles, mumps, and rubella (MMR); tetanus, diphtheria, and pertussis (TDAP); varicella (chickenpox); and Hepatitis B. All 12th graders need proof of two meningococcal immunizations before the first day of school. Additionally, all preschool students need proof of vaccination or immunity from the following: a current annual influenza shot, Haemophilus influenzae type b (Hib), and pneumococcal conjugate (PCV). The School will not offer any exemptions to this policy, except in the case of a New York State licensed physician certifying that such immunization may be detrimental to the student’s health. Such certifications must be submitted to the Head of School. If you are seeking a medical exemption, you must provide a letter from a New York State licensed physician certifying that one or more of the required immunizations are detrimental to your child’s health. The letter should specify which immunizations may be harmful to your child and for how long the immunization(s) would be detrimental.

When to Stay Home

Reasons for which a child may be sent home or for a parent to keep the child at home from school:

• A fever of 100 degrees or above. The child should remain home until fever-free for 24 hours without the use of any fever-reducing medication like Tylenol or ibuprofen.
• Conjunctivitis (pink eye), strep throat, ringworm, and impetigo are all infections that must be treated with medication for a minimum of 24 hours before returning to school.
• Diarrhea or vomiting. The child must remain home until symptom-free for 24 hours.
• Head injury
• Rash of unknown origin
• Severe coughing or difficulty breathing
• Inadequate immunizations with known disease outbreak in the School (chicken pox, pertussis, mumps, etc.). The child should remain home for the duration of the incubation period.
• Children who are sent home or stay home may not return to school for performances, games, or any extracurricular activities.

The Centers for Disease Control and Prevention (CDC) and New York State Department of Health (NYSDOH) provide the following guidance for people who test positive for COVID: if your child tests positive, they are not required to stay home for five days. Instead, they should follow the core prevention strategies (listed below) to protect themselves and others from the health risks caused by respiratory viruses, such as the flu, respiratory syncytial virus (RSV), and Covid.

Core Prevention Strategies:

• If your child is symptomatic with a respiratory virus, keep them home, make sure they wear a mask, and have them stay away from others.
• Symptoms of a respiratory virus can include fever, chills, sore throat, cough, runny nose, and headache.
• Your child may return to school and normal activities when they are fever-free for at least 24 hours without the use of fever-reducing medication (e.g., Tylenol, Advil, Motrin) and once their symptoms have significantly improved.
• When returning to normal activities, the CDC and NYCDOH advise taking additional precautions for the next five days and wearing a mask.
• Testing early allows for treatment (such as Tamiflu and Paxlovid). These antivirals reduce the risk of severe illness and lower the chances of spreading the virus to others. Please discuss this with your child’s doctor.
• Staying up-to-date with immunizations and practicing good hygiene.

For more information, please see the following resources:
https://www.cdc.gov/respiratory-viruses/prevention/index.html
https://www.cdc.gov/respiratory-viruses/downloads/RVG-Summary-Graphic-508.pdf

In any given school year, Saint Ann’s has several students with severe, potentially life-threatening allergies. As it is impossible to make a school allergen-free, Saint Ann’s has adopted an “allergy aware” policy.

Annually, we ask families of children with severe allergies to have their pediatrician complete an allergy action plan. This plan is shared with classroom teachers in the preschool through third grades; in fourth through twelfth grade, the allergy is noted on every class roster. Division offices, deans, and cafeteria staff are also notified regarding any student with allergies.
Below are some steps that the Saint Ann’s community can take to reduce exposure to food allergens in the School. While these precautions are not mandates, we ask for your assistance by following these recommendations to create a safe environment for all students.

• Please teach your children not to share food with other children in school.
• Encourage hand washing and wiping surfaces after meals.
• Avoid sending your child to school with peanuts, tree nuts, or foods made with nuts or prepackaged food with a printed warning label (“may contain peanuts/tree nuts”).
• If making baked goods to be shared at school, please avoid common allergens and label food with all ingredients.
• Contact foodservicehelp@saintannsny.org for help or more information regarding your child’s specific food allergies.

Any injury that requires activity restrictions or has a child using the elevator, a cane, or crutches must be accompanied by a physician’s order describing the restrictions. In order for a child to return to full activity and participate in Recreational Arts, a child must have a written medical clearance from their physician.

Concussion Information

• Parent Concussion Letter
• Information about ImPACT
• Concussion Management Plan
• Concussion Management for Non-Athletes or Concussions Sustained Outside of School
• Head Injury Letter

Any prescription medication must be accompanied by a current written doctor’s order. The medication must be in a prescription bottle where the label matches the doctor’s written order and states the child’s name, dosage, route, and expiration date. All prescription medication is stored in the nurse’s office and may only be given by the nurse as ordered. No employees other than the school nurses may administer any form of medication to a student. It is against NYS Department of Health regulations to do so.

Elevator passes are issued by the nurses for those students who:

• Have a physical disability
• Are injured during the school day
• Have a doctor’s note requiring activity restrictions
• Are experiencing an asthma exacerbation and are unable to participate in activities

If your child has lice, please alert the nurses’ office at nurses@saintannsny.org and let their close friends know. The nurses will email a lice letter to your child’s class notifying them of the case and how to treat lice if detected. If a child is found to have lice at school, we will notify the parents. The child will not be excluded and is allowed to remain in school until they are picked up by their parent or caregiver. However, any student with lice must be treated before returning to school the next day. Please bring the child to the nurse the morning after treatment for a quick check. The nurses can also provide families with resources for lice removal.

The nurses encourage families to make “head checks” part of their weekly routine.

In accordance with the American Academy of Pediatrics, the CDC, and the National Association of Nurses, Saint Ann’s is no longer doing class-wide or school-wide head checks for lice.