LCMR Nurse

Ashley Robinson - HS School Nurse - robinsona@lcmrschools.com
Alyssa Lopez - HS School Nurse Clerk
609.884.3475 ext: 247 | Fax: 609.884.0546

Required Back To School Forms

**All required forms must be updated every school year.

• EMERGENCY CONTACT FORM (opens as a PDF)
  
  
• SCOLIOSIS SCREENING NOTIFICATION (opens as a PDF)
  
  
• Medications
  • Over the Counter Medications
    • Need OTC MED FORM (opens as a PDF) signed by parent/guardian
    • Medications must be supplied from home
    • Medications must be kept in nurse’s office
  • Prescriptions Medications
    • Need PRESCRIPTION MED FORM (opens as a PDF) signed by parent/guardian
    • Need written request/permission from prescribing doctor including medication name, dose, and time to be given
    • Medication must be provided in labeled pharmacy bottle/package
    • Medications must be kept in nurse’s office (exceptions: inhalers, epi pens)
      
      
• New Incoming Students
  • An updated physical from your doctor (from the past year) is required within 30 days of entering the district
  • Vaccine records must be provided, and any outstanding vaccines are required to be obtained within 30 days of entering the district
  • NURSE’S LETTER for INCOMING STUDENTS (opens as a PDF)
  • HEALTH HISTORY FORM (opens as a PDF) (for parent/guardian to provide information)
    
    
• Student Athletes
  • Athletes:  All Students who wish to participate in sports must have a current (within one year) completed sports physical.  All athletes must register for sports with the link below. Return completed sport physical to the school nurse or athletic trainer. 
  • SPORTS PHYSICAL FORM (opens as a PDF) (Updated June 26th 2024)
  • REGISTRATION FOR STUDENT ATHLETES
    
    
• Students with Asthma
  • Provide an ASTHMA ACTION PLAN (opens as a PDF) signed by both parent/guardian and doctor
  • Provide PRESCRIPTION MEDICATION FORM (opens as a PDF) for any medications needed at school
  • Please send required medications to school
  • INFORMATION ABOUT USING A SPACER (opens as a PDF)
    
    
• Students with Allergies
  • Provide an ALLERGY/ANAPHYLAXIS PLAN (opens as a PDF) signed by doctor, or a letter from your doctor stating that epi is prescribed
  • Provide PRESCRIPTION MEDICATION FORM (opens as a PDF) for any medications needed at school
  • Provide EPINEPHRINE FORM (opens as a PDF) signed by parent/guardian AND student
  • Provide OVER THE COUNTER MEDICATION FORM (opens as a PDF) if needed (benadryl/diphenhydramine)
  • Please send required medications to school
    
    
• Students with Diabetes
  • Provide diabetes management plan from your doctor
  • Provide PRESCRIPTION MEDICATION FORM (opens as a PDF) for insulin and/or glucagon
  • Please send required medications and supplies: insulin/syringes/pods, glucagon, glucometer, test strips, lancets, ketone strips, snacks or emergency sugar source, water bottle, etc.
    
    
• Students with Seizure Disorders
  • Provide a SEIZURE ACTION PLAN (opens as a PDF) signed by both parent and doctor
  • Provide PRESCRIPTION MEDICATION FORM (opens as a PDF) for any medications needed at school
  • Provide PARENT QUESTIONNAIRE (opens as a PDF) if you choose to provide additional information
  • Please send required medications to school