• Health Office Forms (click on title to access form)

    Throughout the school year, MEDICAL NOTES related to student absences, injuries, illnesses, and/or hospitalizations should be provided to the Main Office or emailed to the school nurse dnazzaro@bedminsterschool.org

    Epinephrine Form

    Students who may require the emergency administration of epinephrine to treat anaphylaxis must complete this form annually with their health provider and provide medication to the health office (or in possession of a student, if allowed to carry and self-administer.) 

    Asthma Treatment Plan - This form is for students diagnosed with asthma who require medications such as albuterol via inhaler (often with a spacer). Emergency medication should be provided by the parent to the school nurse or may be carried by students with permission to carry and self-administer their meds. 

    Medication Administration Form (prescription or OTC) - This form should be completed for all medications (other than asthma inhalers and epinephrine) that a student might need to receive at school on a routine or “as needed” basis. Use this form for over-the-counter medicine (ibuprofen, acetaminophen, Claritin, etc.) or prescription medicine (ADHD meds, etc.) if they are needed while your child is at school.

    Seizure Action Plan - A seizure action plan such as this or a similar form from your child’s health provider should be completed annually and provided to the school nurse for any student diagnosed with a seizure disorder (epilepsy). Emergency medication should be provided by the parents to the nurse.

    Diabetes Medical Management Plan - Students with diabetes must submit a Diabetes Medical Management Plan (DMMP) such as this or a similar one from their health provider annually. Diabetic medications and supplies should be provided to the school nurse for storage in the health office and/or with the student if permitted by the parents and health provider in the DMMP.NEW

    NEW STUDENT Health History Form - Students entering Pre-K, Kindergarten or transferring into school for the first time should complete this form and submit a recent physical exam on a form available below.  En Espanol 

    Physical Exam for Preschool - Grade 4 Students  - This form can be used to record a student’s yearly well exam. 

    Physical Exam Form for Grade 5 - 8 Students - This form, the Athletic Preparticipation Physical Exam Form, should be used by students in Grades 5-8 to record a yearly physical exam. Click the tab on the left for additional information about SPORTS FORMS.

    NOTE: Physical Exams are required upon students' initial entry to school and yearly for student athletes (grades 6-8). Medical examinations of students at least once during each developmental stage: early childhood (preschool through grade three), pre-adolescence (grade four through six), and adolescence (grade seven through 12) are strongly recommended.