Pre-K through Eighth Grade
50 Byrd Avenue, Bloomfield, NJ | 973-338-8505

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Health History Form All Grades (pdf)
Physical Form PreK - Grade 2 (pdf)
Pre-Participation Physical Forms - Grades 3-8 (pdf)
Head Injury Fact Sheet Page 1 (pdf)
Head Injury Page 2 (pdf)
Sudden Cardiac Death Page 1 (pdf)
Sudden Cardiac Death Page 2 (pdf)
Sudden Cardiac Sign Off Sheet (pdf)
Asthma Treatment Plan and Authorization (2 pages) (pdf)
School Immunization Requirements (pdf)
Food Allergy Action Plan (2 pages) (pdf)
Consent for Medication (pdf)
Religious Exemption (pdf)

School Nurse

Saint Thomas the Apostle School

Health Services Policies and Information

This memo provides important information for parents/guardians of all students attending PreK- Grade 8 regarding Health Services policies and requests for the school year. It is requested that the parents/guardians adhere to the following to promote and maintain the wellness and safety of all students, faculty and staff of Saint Thomas the Apostle School.

A school nurse is available to provide students with limited support and treatment for an illness, injury or medical emergency that occur during school hours. Other medical issues that occur outside of the regular school day should be addressed by the student’s parent/guardian and followed up as necessary with their health care provider (HCP).
Please note that the school nurse does not cover before/after care, after school activities such as sports or clubs and does not accompany students on class trips. In the absence of the school nurse, designated office staff will treat students with minor injuries or illness. The office staff is unable to administer any medication to a student; only the school nurse or parent can administer medication.

• All students, PreK-8, must be in compliance with New Jersey age/grade level vaccine requirements for school attendance. (Refer to the enclosed Immunization Requirements for School Attendance in New Jersey)
• Written requests for Religious Exemption to the student receiving vaccines must be submitted to the school nurse for approval by the Principal. Once approved, a Religious Exemption Acknowledgement form must be completed and returned. This form will be provided by the school nurse and must be re-submitted each school year.
• Medical Exemption for the student not receiving a specific vaccine must be documented by the student’s HCP and submitted to the school nurse. Medical Exemption requests must be re-submitted each school year.
• All new entry and transfer students must provide the school nurse with an immunization record PRIOR to starting school. Parents/guardians will be notified of any deficiencies and are expected to have the vaccine(s) administered and documentation submitted by the date requested.
• All grade level immunizations must be administered, and documentation provided PRIOR to the start of that school year.

• All students in Grades K – 8 are required to have an annual physical on file in the health Office in order to participate in Gym Class and Sports/Cheerleading.
• Physicals expire one year from the date performed. Expired physicals must be renewed and re-submitted to the school nurse within 2 weeks of expiration.
• All physicals in PreK – 2 must be documented on either the physical form provided by the school (preferred) or one provided by the HCP. All physicals are to be submitted along with an updated Health History Form completed by the parent/guardian.
• All physicals in grades 3 -8: As of July 1st, 2014 all physicals in these grades must be documented on the newly required NJDOH Preparticipation Physical Evaluation (PPE) Physical Examination Form and History Form. These forms must be used even if the student is not participating in sports/cheerleading. 
• All physical forms must document the student’s ability to participate in gym class and sports/cheerleading.
• A “note” alone from the HCP that a physical was done will not be accepted. The proper forms must be used!
• The student will NOT BE PERMITTED to participate in gym class or sports/cheerleading until an update physical form(s) is submitted. The student’s gym grade will be affected; the grade will drop 1 level for every 3 classes missed.


• Parents/guardians are asked to please inform the school nurse if their child has asthma or an asthma –related condition, such as Reactive Airway Disorder “RAD”
• Any student who requires the use of asthma medication during school hours MUST provide the school nurse with the following forms:
        1)   Asthma Treatment Plan (signed by both parent/guardian and health care provider)
               2)   Signed Parent/Guardian Authorization and Release Form
               3)   Prescribed medication and nebulizer tubing (if not approved to self-administer)
• These students may carry on them and self-administer their own inhaler ONLY if authorized by parent/guardian and physician on the required forms. These students are responsible for having their inhaler at school and with them at all times, as well as on class trips.

• Parents/guardians MUST inform the school nurse if their child has a life-threatening food or other allergy which may require emergency use of epinephrine (Epi-Pen).
• Any student who has a life-threatening food allergy and may require emergency epinephrine to be given during school hours must provide the school nurse with:
1) Food Allergy Action Plan (signed by both parent/guardian and health care provider)                                           
2) Signed Parent/Guardian Authorization and Release Form
3) Prescribed medication (if not approved to self-administer)
• These students may carry on them and self-administer their Epi-Pen ONLY if authorized by their parent/guardian and health care provider. These students are responsible for having the Epi-Pen at school and with them at all times, as well as on class trips. (Benadryl can only be administered by the school nurse.)
• All food for these students must be provided by the parent/guardian.
• Class parents/guardians will be notified of any food allergies in their child’s class and are asked not to send in these specific food items into the classroom with their child.
• Non-food treats are encouraged for birthdays and other class celebrations.
• If food is sent in for these celebrations they must be pre-packaged, listing all product ingredients.
• In the event that emergency epinephrine is given, the emergency squad will be called.

• Parents/guardians MUST inform the school nurse if their child has diabetes.
• Blood glucose testing and insulin administration instructions from the child’s health care provider must be submitted to the school nurse.
• All blood glucose testing and insulin administration must be done in the health office under the supervision of the school nurse.
• All medications, testing supplies, juice and snacks are to be provided by the parent/guardian.
• If the student does not have a” volunteer” delegate, as required by law, to administer Glucagon in the absence of the school nurse, the parent/guardian must then accompany their child on any class trip.
• In the event that Glucagon is given, the emergency squad will be called.

Parents/Guardians are asked to inform the school nurse of any other illness or medical condition that their child may have. A HEALTH HISTORY FORM must be submitted on each student for each school year.

• Only the school nurse or the parent/guardian can administer medication to the student during school hours.
•  All medications, whether prescribed or OTC, cannot be given unless a written request, signed by both the health care provider and the parent/guardian, is submitted to the school nurse on the provided MEDICATION PERMISSION FORM.
• Medication will be kept in the health office for the duration of the treatment.
• Medication must be brought to and taken from school by the parent/guardian or other adult.
• Parents/guardians are asked to medicate their child if necessary (i.e. for headaches, sore throats, muscle injury, cold/.allergy symptoms etc.) prior to the child coming to school.
• Parents/guardians are also welcome to come to school and medicate their child only if necessary or requested by the school nurse.
• Except for those students who have written approval by their HCP to carry on them and self-administer their asthma inhaler or Epi-Pen, students are ABSOLUTELY NOT PERMITTED to have any medication, prescribed or OTC, with them at school. This includes having it in their backpack, pocket or giving it to a teacher to hold and give. All medication must be kept in the Health Office and have the required form for administration.
• If a student is found to have unauthorized medication with them at school, the medication will be taken away and parent notified. The medication will be kept by the school nurse until picked up by the parent/guardian.


The school nurse is authorized to exclude students from school for the following:
• Failure to submit an immunization record for any transfer/new entry student
• Immunization deficiencies for age/grade level not administered by the requested date
• Communicable and vaccine preventable disease (VPD)
• During a VPD outbreak for any student claiming a religious exemption from receiving vaccines and those claiming medical exemption to the specific vaccine
• Non-compliance in the return to school policy for head injury/concussion or head lice
• Non-compliance in receiving the state mandated seasonal flu vaccine between 09/01 and 12/31 for all PreK children. These children can be excluded through March 31st (end of flu season) or until the vaccine is given.
• At the specific request of the School Principal

• Any student who sustains a head injury with signs of possible concussion during school hours or school sponsored sports/cheerleading will be immediately sent home from school or removed from practice/competition. Parents/guardians are asked to also notify the school nurse and coach if their child sustains a head injury with possible concussion outside of school or school sponsored sports.
• These students MUST be evaluated by a physician or other licensed health care provider who is trained in the evaluation/management of a concussion in order to determine the presence/absence of a concussion.
• Written medical clearance must be submitted to the school nurse and/or coach BEFORE the child can return to school, gym class or sports/cheerleading.  This clearance must include whether or not a concussion was present and restrictions, if any, in returning to school, gym class and sports/cheerleading.

• Students with vomiting, diarrhea or temperature of 100 degrees F or above MUST stay home from school and school-sponsored sports/clubs until they are free of the above for 24 HOURS, without the use of any medication to control these symptoms.
• Students who have a contagious bacterial infection (such as strep throat and pink eye) MUST be on an antibiotic for at least 24 HOURS before returning to school, and school sponsored sports/clubs.

• Students who have been diagnosed with or are suspected to have the flu should stay home from school for at least 5 days from the onset of symptoms (contagious period) and be fever free as above before returning.
• Please teach/remind your child to cover their mouth with arm/elbow when they cough or sneeze, not to share their food or drink and to wash their hands frequently.
• Seasonal flu vaccines are strongly recommended. This is a state requirement for all PreK students.

• Any student, who has a suspected or confirmed case of head lice, whether detected at school or at home, MUST be sent/kept home from school. The student MUST be treated with a medicated shampoo approved for the treatment of head lice, such as Rid or Nix, AND be “nit free” before they may return to school. (Nits are viable lice eggs which are oval in shape, light gray or whitish in color and which strongly adhere to the hair shaft close to the scalp. Unlike hair product debris or dandruff, viable nits are difficult to remove manually.)
• These students MUST be checked by the school nurse BEFORE they can re-enter their classroom.
• The affected student’s class will only be checked if more than one case is detected in that particular class.
• A written notice of possible exposure will be sent home to the parents/guardians of the remaining student in the classroom and other students who may be affected. It will be the responsibility of the parents/guardians to check their child’s hair over the next 2 weeks for the presence of lice/nits.
• The school nurse must be notified if head lice are detected on your child at home.
• Please teach/remind your child not to share hair accessories such as combs, brushes or hats.
• It is recommended that long hair be tied up and off the shoulders and boy’s hair be kept short.

Parents/guardians or alternate emergency contacts must pick up the student being sent home within ONE HOUR of being contacted. Please notify the school ASAP of any change in your home, mobile and work phone numbers, as well as changes in listed numbers for alternate emergency contacts. EMERGENCY CONTACT CARDS are to be submitted to the school nurse at the beginning of each school year. PLEASE ALSO PROVIDE A PARENT/GUARDIAN E-MAIL ADDRESS.

 STUDENT ABSENCES (does not apply to Preschool)
• Any student with an “unauthorized” (not pre-approved) absence from school for 3 or more consecutive school days is required to submit, upon their return, a written statement from their HCP) as to the reason for the absence and the date they are allowed to return to school/gym class/sports and any restrictions to activity if necessary.
• A note from the HCP may also be requested for those students who are frequently absent or upon request from the Principal.

• Any student who comes to school wearing a sling, cast, brace or other supportive device MUST submit to the school nurse a written statement from their HCP as to the reason, duration and activity restrictions.
• Students are absolutely not permitted to use crutches at school unless they submit a written request from their HCP as to the reason and duration. Without this request from the HCP, the student will be sent home.
• Requests alone from a parent/guardian will not be accepted.

• An elevator pass will only be issued if the student is physically unable to safely use the stairs. (i.e. use of crutches or lower extremity injury with supportive device)
• Students who require use of the elevator for medical reasons, other than above, must submit a written request from their HCP as to the reason and duration.
• Requests alone from the parent/guardian will not be accepted.

• A written request from the student’s HCP must be submitted in order for the student to be excused from gym class. The request must include the reason and duration of the excuse.
• Requests alone from the parent/guardian will not be accepted.
• Any student who has been granted a gym excuse due to the above is NOT PERMITTED to physically participate in school recess or school sports/cheerleading for the duration of the excuse.
• As deemed necessary, the school nurse will issue a 1 time gym excuse for a student who sustains an injury at school that day.

• Notifications will be sent home to the parent/guardian for:
1) Head injuries
2) Exposure to communicable or vaccine preventable disease
3) Exposure to head lice
4) Classroom food allergies
5) High incidence of illness in classroom
6) Immunization deficiencies, physical updates and other missing required forms for the school year
(These notifications may also be done via e-mail.)
• Referrals for medical follow-up will be sent home to the parent/guardian for:
1) Any student who fails a state required school health screening (vision, hearing, scoliosis)
2) Any student who sustains a head injury with signs of possible concussion
3) Any student who has a health issue that is of concern

• Please encourage your child to eat breakfast before school. Because of the possibility and high incidence of food allergies, the school nurse does not provide food/drink (except for water) for these students.
• Please provide healthy snacks and lunches.
• Please check the “Nurse’s Notes” section of the weekly school newsletter that is posted on the school website every Friday. Here you will find other general requests, reminders, as well as important updates and information. In certain instances, as deemed necessary by the Principal/school nurse, Honeywell phone alerts will be initiated to all or specific families in order to get important/time-sensitive information out quickly.


Please feel free to contact the school nurse at 973-338-8505 if you should have any questions or concerns. Appointments
are preferred if a meeting is requested.

All Health Services forms can be obtained from the main office or school nurse. Most are also available on-line @



Please keep this information available so you can refer to it
as needed during the school year.



Please make sure to update and submit your child's annual physical report to the school nurse by August 15,2017 in order to prevent any delay in gym class participation (Grades K-8) and sports participation (grades 6-8). Physicals expire 1 year from the date performed.All medical forms needed for your child can be found below: