HEALTH PLANS:

Asthma EAP 24 This form includes a place for the doctor’s order for use of an inhaler or nebulizer.

Diabetes Plan 24 Form for Type 1 Diabetics.  This form includes a place for the doctor’s order for glucagon/baqsami.

Severe Allergy EAP 24 This is for any severe allergy and includes the doctor’s order for Epinephrine and benadryl (ex: peanut, tree nut, bees, etc.)

Seizure EAP 24 This form is for any student that has seizures and includes a section for the doctor’s order for rescue medicine.

MEDICATIONS:

Medical Authorization Form This form is completed by the parent and doctor for any medication that is prescribed and the student will need to take at school.  Please only use this if there is no other option for the student to receive the medication.  We recommend giving students their medications at home before school or after school when possible.

Over the Counter Medication Form – This is ONLY used at the middle school and high school level.  If your student is at the elementary school or middle school, they MUST have the medication authorization form completed and medication must be given by the nurse or trained school employee.

OTHER FORMS:

Physician Order for G-tube Feeding Procedure – G-tube feeding Doctor’s order

Concussion Paperwork – This should be completed by a physician or medical personnel when a student has a concussion.  The paperwork should be returned to the school nurse so that it can be distributed properly to staff that are involved in your student’s care.

**If your student is an athlete at the middle school or high school please contact the athletic trainer for more information on returning to sports.  Even if the injury occurs during the off season, your athletic trainer should be notified.**

Celiac – Forms for Celiac student.  Please also complete a diet order for the Nutrition Dept.

Diet Order – Please complete with physician and return to School Nutrition

Health Assessment Form – If your student is NEW to NC schools - Kindergarten or transfer from out of state, this form must be completed and turned into your school nurse within the first 30 days of your student’s start date.

If your child has a health condition that needs special assistance and/or an emergency action plan at school, please contact your school nurse. Examples of health conditions that the nurse needs to talk to parents about include diabetes, asthma, severe allergy, seizures, etc. The nurse will work with school staff to ensure that your child’s special health care needs are met.

Each student's parent/guardian needs to provide all health/emergency information online in Powerschool. This information needs to be provided immediately upon enrollment so that your directions may be followed in an emergency. Please follow the directions in Powerschool and submit all requested information including current parental/guardian contact information (home, work, and cell phone numbers) and other emergency contacts and numbers such as a relative, neighbor, or friend. When sickness or accidents occur at school, parents are notified as soon as possible. It is critical that the numbers/information be updated and kept current during the school year. It is extremely important that we are able to reach you in the event of an accident or illness.  Hard copy forms are available at your child's school upon request.

Children perform better at school when they are well nourished and get adequate sleep (needing as much as 9-11 hours each night). Regular school attendance is important, but children who are sick need to stay home to recuperate. A student who is vomiting, has diarrhea, or is running a fever of at least 100 degrees should not be sent to school.

School personnel will notify parents if a child appears to have signs and/or symptoms of a communicable disease or condition so that they can seek medical advice or attention. Students will be excluded from school for the period of communicability and readmitted in accordance with recommendations from their health care provider and /or the DHHS Regulations for Control of Communicable Diseases.

In the event that a student is involved in an incident where they may be exposed to another person’s blood or body fluids, the MGSD post exposure protocol will be followed.

General Statute (G.S.) 130A-152 requires that every child be immunized against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, Haemophilus influenza type b (Hib), hepatitis B, varicella, and meningococcal disease. Parents/guardians will be informed of the North Carolina immunization requirements when they register their child in school. No student may attend any grade (Pre-K-12) without presenting a certificate of immunization. The parent/guardian has 30 calendar days from the student’s first day of attendance to show proof of the required immunizations or provide evidence that they are in the process of completing their immunizations. For specific immunization requirements, refer to the following website:

Immunize NC

Religious or medical exemptions from this law require that a statement be on file at school in the student’s cumulative record.

NC General Statute 130A-440 Beginning the 2016-2017 school year, if your child is enrolling in Kindergarten or in a higher grade in a NC public school for the first time, a completed Health Assessment must be on file at school. The health assessment shall be completed no more than 12 months prior to the date of school entry.

Health Assessment Form

Parents will be asked to sign and provide a copy of the North Carolina Immunization and Health Assessment Requirements form when they register their child in school.

Immunization and Health Assessment Requirements

Requisitos de Inmunizacion y Chequeo de Salud de North Carolina

In order for a student to receive prescription and non-prescription medicines at school, a parent/guardian consent and written authorization from a licensed health care provider are required. Medications cannot be given to a student at school until a Medication Authorization form has been received. A separate form is required for each medicine. New authorization forms are required every year at the beginning of school, whenever the dose or directions change, or when a new medicine is prescribed. It is the parent’s responsibility to provide all medicines to be given at school. Each medicine must be in an appropriately labeled pharmacy container that corresponds with the completed Medication Authorization form. Most pharmacies will provide an extra container for school use upon request. Over the counter medications must be in the original non-prescription container. Students are prohibited from transporting medications to and from school unless it is an emergency medication (examples-metered dose inhaler, glucagon, epipen, etc.) and proper authorization is in place.

• Medication Authorization Form
• Autorizacion Para Medicamentos

Middle and High school students may self-carry and administer over-the-counter medication per the following guidelines. Students in elementary school are not permitted to self-carry over-the-counter medications.

• English OTC Form
• Spanish OTC Form

All medications must be picked up at the end of the school year by a parent/guardian. Any medication not picked up by the end of the last day of school by a parent/guardian will be discarded.

No student shall give to or receive from another student any medication, either prescribed or over the counter. Any such exchange may be considered a serious offense and may result in suspension.

Students with special health care needs may require medical procedures during school hours. The school nurse will develop a healthcare plan for the student in collaboration with the family, student, and physician. Specialized medical procedures require an Authorization for Treatment form completed by the student’s healthcare provider and signed by the student’s parent/guardian. This form must be updated at the beginning of each school year.

Healthcare Procedure Authorization Form

Parents of a student with special dietary needs must provide the school with documentation from a licensed healthcare provider describing the specific health condition of the student. The school nurse in collaboration with the parent/guardian and student will develop a plan of care. The Diet Order-Medical Statement for Students with Special Diet Needs must be completed and forwarded to Child Nutrition.  

The Diet Order Form only needs to be completed once, unless there are any changes to the current diet. 

MGSD Diet Order Form

Vision and hearing screenings are conducted on students because of the obvious relationship to learning. School nurses conduct vision screenings, make referrals, and follow-up with these referrals as needed. Speech clinicians and audiologist conduct audiometric hearing screenings and refer as needed. School nurses assist with the follow-up of these referrals.

If your student is a school athlete, and has been diagnosed with a concussion or TBI please contact your school athletic director. 

If you are not a school athlete, notify your school nurse for proper Return-to-Learn procedure. 

Return to Learn after a Concussion