Parents

Health Forms

Below are the required health forms for the 2014-2015 academic year. These are the only forms that will be accepted, with one exception: the immunization record may be a copy of your son’s on-going records from his health care provider. We encourage you to review the enclosed 2014-2015 D.C. Immunization Requirements with your son’s health care provider to ensure compliance. Please note the requirement for the Human Papillomavirus vaccine (HPV) and Vaccination Opt Out form included here.

The Asthma Action Plan and the Action Plan for Anaphylaxis are required if your son has either asthma or anaphylaxis due to any cause. The STA Prescription/Non-Prescription Medication Administration form is to be used for all other medications ordered by a health care provider to be administered at school.

Every student must have an annual physical. The health forms are effective for one year from the date of that physical. If the forms expire during the academic year, your son will need to have another physical and submit new forms. (The school offers a two-week grace period for having the exam and submitting the forms). Please renew the STA Permission for Emergency Medical Treatment form when you renew the D.C. Health Certificate.

If your son is new to the school this academic year and has had a recent physical exam, please have your health care provider fill out and sign the D.C. Universal Health Certificate, including sports clearance.

Dental exams are now required annually for all students.

To expedite the processing of forms, area physicians and dentists have asked that you complete all but the professional sections of the forms before submitting the forms to them. Please do so.

No student may register, obtain books, or attend classes until a complete set of his health forms is on file in the nurse’s office at the School. We ask that you return the forms by August 11, 2014.

We look forward to working with you to ensure the health and safety of your sons in the upcoming year, and thank you for filling out these forms completely and accurately.

Sincerely,

Jerilyn Stone, R.N., B.A.
St. Albans School Nurse
202-537-6433

Gregory Parker
Director of Finance and Business Operations


Below are electronic copies of Health Forms for the coming year. Using Adobe's free Acrobat Reader, one can read and print the forms listed below.

PERMISSION FOR EMERGENCY TREATMENT

Please Note:

  • Parent's/guardian's signature required for administration of over-the-counter medications by the school nurse.

  • Parent's/guardian's signature required for emergency medical treatment.

  • A physician's signature is required for the administration of over-the-counter medications by the school nurse, the resident faculty (for resident students only), the athletic trainers, STA/NCS Voyager staff, and non-medical school employees (Field trips only).

Permission for Emergency Medical Treatment Form

DISTRICT OF COLUMBIA IMMUNIZATION REQUIREMENTS SCHOOL YEAR 2014-2015

All students attending school in the District of Columbia must present proof of appropriately spaced immunization by the first day of school.

Immunization Requirements Flyer

DISTRICT OF COLUMBIA UNIVERSAL HEALTH CERTIFICATE

 Please review your son’s immunization record with his health care provider and update his immunizations as required.

DC Health Certificate Instructions

DC Child Health Certificate

Human Papillomavirus (HPV) Vaccination Opt Out Form and Instructions

MEDICATION ADMINISTRATION RELEASE FORM

This form must be completed and signed by a parent/guardian and the prescribing physician if your son is to receive prescription or prescribed over-the-counter medication during the school day. Please make a copy of the medication administration form for each medication to be administered.

Medication Administration Form

ACTION PLAN FOR ANAPHYLAXIS

If your child has an allergy that may result in the need of an EpiPen, this form must be completed and signed by a parent/guardian and the prescribing physician.

Action Plan for Anaphylaxis

ASTHMA ACTION PLAN

If your child has asthma, this form must be completed and signed by a parent/guardian and the prescribing physician.

Asthma Action Plan

DISTRICT OF COLUMBIA ORAL HEALTH ASSESSMENT FORM

All students are required to have an oral health assesment annually.

DC Oral Health Assessment Form

MEDICATION REQUIRED FOR OVERNIGHT FIELD TRIPS

This form is for overnight trips only, and is to be filled out and returned two weeks prior to the trip.

Overnight Field Trips Medication Form

St. Albans School, Mount St. Alban, Washington, DC 20016, 202-537-6435