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Dev.isps.edu.tt

STUDENT HEALTH RECORD FOR REGISTRATION
Name _____________________________________________________________________________________________________ M F Date of birth _______________________________ Grade entering this year ______________________________ Parent’s/Guardian’s name _____________________________________________________________________________________________ Address _______________________________________________________________________________________________________________ Home telephone no. _________________ Cellular phone no. _________________ Office telephone no. _________________ In case of emergency call ____________________________________________________ Telephone ___________________________ Physician’s name ____________________________________________________________ Telephone ___________________________ In case of emergency, I authorise the school to use its judgment, if no authorised person listed above can be reached SIGNIFICANT MEDICAL HISTORY
Disease/Condition
immunization records or complete the table below.
Vaccination/Immunization
Allergies: ____________________________________________ _______________________________________________________ (Please specify if your child has specific medication and send it with dosage noted) Surgery ______________________________________________ _______________________________________________________ STUDENT HEALTH RECORD FOR REGISTRATION continued
Emotional or mental patterns of which the school should be aware of (Phobias, Anxieties, etc.) _______________________ Ethnic/Nutritional/Religious customs (helpful for field trips) __________________________________________________________ Most recent physical exam ____________________________________________________________________________________________ Medication your child takes on a regular basis _________________________________________________________________________ Restrictions on Physical Activity ________________________________________________________________________________________ BLOOD TYPE ________________________________ Group ___________________________ Rho ______________________________ COMMENTS ___________________________________________________________________________________________________________ CONSENT FOR “OVER THE COUNTER” MEDICATIONS
I give permission for my child, __________________________________________________________________________ , to receive anymedication I have indicated here below as deemed necessary by the school nurse. I understand that genericequivalent medications may be used in place of brand-name items.
PLEASE CHECK ANY “OVER THE COUNTER” MEDICATIONS YOU WISH TO BE MADE AVAILABLE TO YOUR CHILD
UNDER NURSING DISCRETION, DOSAGE DETERMINED BY AGE AND/OR WEIGHT
For headache/fever/muscle aches, menstrual cramps

Ibuprofen (like Advil, Motrin) – best for menstrual cramps, muscle/bone pain, For mild allergic reactions (such as hives, seasonal allergies)

For mild cold symptoms

For mild stomach discomfort

For mild skin irritation (insect bites, minor rashes, abrasions)

I do not want any medication given to my child in school
I understand that the above medications I have checked will be administered by the school nurse, or herdesignee.
Year ______________________________________________________________________________ Signature __________________________________________________________________________ _______________________________

Source: http://dev.isps.edu.tt/wordpress/wp-content/uploads/2012/12/health-record.pdf

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CHEFSCATALOG.COM QUARTERLY RATINGS AND REVIEWS $250 CHEFS GIFT CARD SWEEPSTAKES THE FOLLOWING SWEEPSTAKES IS FOR PLAY IN THE UNITED STATES ONLY AND SHALL BE CONSTRUED AND EVALUATED ACCORDING TO UNITED STATES LAW. DO NOT ENTER THIS SWEEPSTAKES IF YOU ARE NOT LOCATED IN THE UNITED STATES AT THE TIME OF ENTRY. YOU MUST BE AT LEAST 18 YEARS OF AGE TO PARTICIPATE IN THIS SWEEPSTAKES. ALL ENTR

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containing a drug concentration less than the cut-off will generate a line in the test INTERPRETATION OF RESULTS To serve as a procedural control, a colored line will always appear at the control line NEGATIVE:* Two lines appear . One red line should be in the control region (C), region, indicating that proper volume of specimen has been added and membrane and another apparent red or pin

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