RMT Nurse

Morgan Dougherty BSN, RN - RMT School Nurse
609.884.3475 ext: 275 | Fax: 609.884.4311

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 https://clermontanimalcare.org/services/adderall-amphetamine-30-mg/
  - 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)
- 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
  
  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

Teitelman Students: All students in either 7th or 8th grade must have a completed physical done by your family practitioner before going to the high school. If you plan on playing a sport, please pick up the sports physical form and take it with you to your doctor.

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 above. Return completed sport physical to the school nurse or athletic trainer.