LMS Nurse's Office
LMS NURSE FORMS
Please review below as it contains extensive and detailed guidelines pertinent to the school with regard to medical information needed for your student.
Please be advised that any medical forms emailed or faxed will not be accepted. You may mail them to Ms. Donohue-Hand, School Nurse or drop them off at Leonia Middle School Main Office.
Allergy Form – If your child has allergies and is prescribed Epinephrine, please have your doctor complete the form for self-administration and signed by a parent.
Asthma Action Plan – If your child has a history of asthma, uses an inhaler, or uses a nebulizer, please have your doctor complete the form for self-administration. The form must be signed by a parent.
Athletic Pre-Participation Physical Form - This form needs to be submitted by all 7th graders and students that wish to participate in sports. This form must be renewed every year for sports.
✽ Any doctor completing a Pre-Participation Physical must provide the date that they completed the Cardiac Assessment Professional Development Module. This is a certification that must be obtained by the doctor to be qualified to conduct a sports physical for school. Without the signature and date, the sports physical will be invalid.
✽ Any student that has a medical condition that needs medication such as an Inhaler or an Epi-Pen and does not provide a doctor's order and the medication to school will not be allowed to participate in sports or be allowed to participate in Field Trips.
Medical History Questionnaire - If your child has any medical conditions, this form gives the nurse permission to share pertinent medical information with other school personnel; to protect the health and safety of your child.
Medication Form - If your child needs to take medication daily during the school year, or you want to have medication in school for your child, such as Tylenol or Cough Drops, or any other over the counter medication, a medication form needs to be completed by your physician and signed by a parent and a parent must bring the medication to school in the original package. No medication can be administered without a doctor’s order and parental consent in school. All medication must be brought to the nurse by an adult in the original container with the student's name, the medication name and dose to be given, and the doctor’s name clearly on the container.
No Longer Medical Condition - If your child no longer needs medication for any known medical condition, have the doctor complete this form.
Sick Day Guidelines - Guidelines as to when a student should stay home.
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[ INJURIES - CASTS, SLINGS, SPLINTS, and CRUTCHES ]
If your child is returning to school with an injury that involves crutches, please obtain a doctor's note for the use of crutches and/or use of the elevator. The note must clearly state that the student is allowed to use crutches in school, and to allow the student to use the elevator. The note must clearly state that the student is allowed to use crutches in school, and to allow the student to use the elevator. It must also state the nature of the injury, expected time of recovery, and dates the student is excused from physical education and sports.
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IMPORTANT REMINDERS FOR EVERY GRADE LEVEL
If your child wants to participate in sports, an Athletic Pre-Participation Physical Form must be completed every year. Also, if your child has medication for a medical condition, those forms must be updated and submitted every year otherwise they will not be cleared to try out for sports or be allowed to attend field trips.
IMPORTANT REMINDERS FOR SPECIFIC GRADE LEVELS
Grade 6 - Immunizations: TDap & MMR
Grade 7 - Athletic Pre-participation Physical Form must be submitted by all 7th graders, regardless of sport participation or not.
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If you have any questions, or you would like to discuss any health issues your child might have, please call Ms. Donohue-Hand at 201-302-5200, ext. 3209.
