Health Forms
Below are the required health forms for the 2013-2014 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 ongoing record from his health care provider. Please review the 2013-2014 D.C. Immunization Requirements with your son's health care provider to ensure compliance.
Please note two new forms: the Asthma Action Plan and the Action Plan for Anaphylaxis. If your son has either asthma or anaphylaxis, due to any cause, the appropriate form must be filled out and signed by his health care provider, signed by a parent or guardian, and returned to the School Nurse with his health packet.
Every boy must have an annual physical effective for one year from the date of the exam. If the exam expires during the academic year, another exam must occur and the appropriate form(s) must be submitted to the School no later than one year and two weeks from the original exam.
If your son is new to the school this academic year and has had a recent physical exam, please have his health care provider fill out and sign the D.C. Universal Health Certificate, including the sports clearance, and submit this form to the School Nurse.
Dental exams are required for students entering Forms B, I, III, and V (Grades 5, 7, 9, and 11).
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 12, 2013.
We look forward to working with you to ensure the health and safety of your sons in the upcoming year, and thank you for your filling out these forms completely and accurately.
Sincerely,
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Jerilyn Stone, R.N., B.A.
St. Albans School Nurse
202-537-6433
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Gregory Parker
Director of Finance and Business Operations
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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:
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Parent's/guardian's signature required for administration of over-the-counter medications by the school nurse.
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Parent's/guardian's signature required for emergency medical treatment.
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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 2013-2014
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
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 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 entering grades 5, 7, 9 and 11 must have a dental examination done after April 15. (Dental exam is not required for students entering grades 4, 6, 8, 10, and 12.)
DC Oral Health Assessment Form
MEDICATION REQUIRED FOR OVERNIGHT FIELD TRIPS