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Health Forms
Student Physical Exam - Private Physician (pdf)
Emergency Health Information (pdf)
OTC Medications Permission Form (pdf)
Scoliosis Form (pdf)
Epi Pen: administration by a delegate- parental permission (pdf)
Administration of Medication, part 1 (pdf)
Administration of Medication, part 2 (pdf)
Self Administration of Medication (pdf)
Family Life Letter For Parents - K-4 (pdf)
Class Parties (pdf)
Asthma Action Plan (pdf)
Food Allergy Action Plan (pdf)

Dear Parent/ Guardians,

I have put most of my forms/letters on this page for you to be able to print them out for yourselves.

Please fill in the forms sent home in September as soon as possible. If you loose them, they are on this page. The Health and Emergency Information form needs to be updated every year.   This will help me to have the information that I need to assist your child if he/she becomes ill at school.  Computers don't always work and If a substitute nurse is here, she will need this information in writing for each student. 

I will screen students for height, weight, vision, hearing and blood pressure once every year.  If the student does not pass the screening, I will send home a referral for you to have him/her checked by your family physician. This will help our students to perform their best in school.   I will also check grade 4,6,8 in May for Scoliosis or back curvature.  This is required every 2 years for students as they grow the most, 10-18 years of age.  If you refuse to have it done in school, please be sure to get it done by your family physician.

If your student needs any medication during the school day,  a written physician's order is required. The medication form is listed on this page for you. This includes any over the counter medications such as advil.  I do send home an OTC permission form in the beginning of the school year which includes acetaminophen which is ordered by Dr. Cullen, our school doctor.  If you need help getting  a physician order, please call me.

Please call or email me if your child will be absent.  Include any symptoms that he/she may have.  This will help me predict any outbreaks.  You can leave a message for me as I listen to voice mail frequently.  My office number is 908 459 4687.  My email is mweigly@hope-elem.org.  If you email me it will count as an absentee letter.


Mary Jane Weigly, RN, CSN



Check back often.