Health Forms
Medications
Accident or Injury

Mount Saint Dominic Academy has a full-time nurse who teaches various health courses, oversees student health, regulations and protection, and cares for the students who are ill or injured at school. Parents and students must share with the nurse any medical problems or concerns that might affect a student’s health, safety, or academic performance.

Health Forms

• According to the State of New Jersey, a current physical examination by a physician must be on file for all new students entering our school, which includes all freshmen and transfer students.  By state law, no student will be permitted to attend school without proper immunizations. we also require that all students who participate in any sports activity, regardless of grade level, have a current physical examination attesting to their fitness to participate.  Documentation for this physical is due by the first day of tryouts. DOWNLOAD General Medical Form for Freshmen, Athletes and Transfer Students.

• All physicals are to be completed on the state mandated New Jersey Department of Education athletic Pre-Participation Physical Examination Form.  This incorporates all forms of sports including physical education classes.  Note: once this physical is 60 days old, a student participating in more than one sport must have a Health History 60 Day Form completed by the first day of tryouts for the winter or spring sport.

• All physicals must be in the office of the school nurse not later than August 1.  The exception will be incoming freshmen or transfer students who wish to participate in MSDA summer sports/activities; they must have their physicals by July 1st.  If this is not done, your daughter will be denied participation in schoolwork and/or sports until a current physical is obtained.  Download New Jersey Department of Education Athletic Pre-Participation Physical Examination Form for the Freshmen, Transfer Students and Athletes.

Medications

The following regulations regarding the use of medication in school have been adopted by Mount Saint Dominic Academy:

• The Health Office must receive written notification of all medications the student is currently taking. For emergency purpose a 3 day supply should be maintained in the Health Office. DOWNLOAD Medication Form

• Written orders are to be provided by the private physician outlining the diagnosis, the medication, and the time the medication should be given. The medication should be brought to school with the written order in the original container, properly labeled by the pharmacist or doctor. No medications, prescriptions or non-prescription may be given in school without a doctor’s note. A written permission form must be signed by the parent.

• As of December 23, 1993, the law regarding the carrying and self-administration of medication for life threatening illnesses, such as asthma, bee stings, diabetes, and other acute problems, was put into effect. If there is an essential need for the student to carry insulin syringes in her possession, the Head of School and nurse must be made aware of this order.

  The doctor must certify in writing that the child has a life threatening illness,, stating the nature of the illness, the medication required, and the ability of the patient to self-medicate. The permission slip must be signed by doctor and parent holding the school harmless against injury or claim that might arise from the self-medication. The permission note is effective for the school year and must be renewed annually.

• For your child to receive Tylenol or Advil, a parent must sign the medication administration form.

Accident or Injury

If a student is injured on school property, the nurse will provide emergency first aid care. If additional care is needed, the parent will be contacted, and if necessary, an Emergency Unit will be called. According to hospital policy, students who are taken to the hospital emergency room can be given only life-saving emergency treatment unless a parent or guardian is present. It is, therefore, essential that the school nurse and the school office have a current home and business number where the parent can be reached in an emergency. An official accident report form, available from the school nurse, will be provided. In any on-site, life-threatening emergency, the school nurse will follow the Standing orders on file in the Health Office.