Student Information

Physician Information

Insurance Information

Dental Screening: State of Rhode Island school health regulations require dental health screening information as part of the school health program.

Allergies

If YES to any of the above please complete the forms below that apply:

Medication AuthorizationRequired for any medication that is administered during the school day.

Food Allergy and Anaphylaxis Emergency Care Plan 

Asthma Action Plan

Additional Health Information

If a prescription medication is to be given at school, you will need to submit either a Medical Authorization Form signed by the doctor or a doctor’s written order. The medication needs to be in its original prescription bottle with appropriate labeling. All medication will be kept in the nurse’s office. Students are NOT allowed to carry any medications with them during the day, with the exception of asthma inhalers, or epinephrine devices.  Please contact the school nurse with questions.
Medical Authorization Form 

Please provide an email address where we can send a link to your current form.

Email Address :