Maria Kansy, RN School Nurse
Tel: 355-5854
Fax: 355-5853

All medical forms submitted must be ORIGINALS, signed and dated by the physician.  Faxes may be received from Physicians.

• Summer Health History
• Medical Updates
• Emergency Contact Update
• Current Physical Exam

NYS law for school entrance and attendance requires proof of immunizations and/or immunity.  This includes: diphtheria toxoid (DTaP, DTP); polio (IPV, OPV); measles, mumps, rubella (MMR); hepatitis B; and varicella.  Proof of immunization and/or immunity must be provided by a licensed health practitioner.

NYS law requires that all students enrolled in grades 2, 4, 7, and 10, as well as new entrants must have a medical examination performed by a private or school physician.

Health Exam Form

The MVCSD school medical examination consists of weighing and measuring, observation of general health, examination of nose, throat, skin, teeth, glands, muscles, joints, groin, abdomen, spine, posture, heart, and lungs.  The school nurse is present during examinations and will promptly advise parents of any potential problems discovered in this examination.

School Physical Permission Form

Must have physician's orders for medication to be dispensed at school, for both prescription and OTC (over the counter) medications.  School law requires the following: Medication Form

• Name of medicine
• Reason for giving
• Dosage
• Time
• Number of days to be dispensed
• The medicine must have a professional label.
• It must be brought to the Health Office / School Nurse by an adult.  Under no circumstances is a child to bring medicine to school.
• The parent or guardian must submit a written request to the school nurse to dispense the medicine as directed.
• The medication will be destroyed seven days after the final dosage is required.  The unused medication may be picked up by a parent/guardian within this period.
• All medications that are not picked up at the end of the school year will be destroyed.

Students must have a note from a physician in order to be excused from physical education class.  Note must include medical reason for excuse.  In addition, a physician

• Students should be temperature free for 24-hours before returning to school after an illness.
• Students should have completed a 24-hour antibiotic cycle before returning to school.
• Contact the health office with any information about exposure to communicable disease and/or health problems