Health Forms

Nurse's Office Section from the Student Handbook

The Health Office is open from 7:30 a.m. to 2:51 p.m., and a Registered Nurse is on duty. Students must have their teacher contact the nurse by phone - prior to reporting to the nurse’s office and should not report between classes.  Any student not following this procedure may face disciplinary action.

In order to ensure the health and well-being of all students at Canaseraga Central School, parents and students must abide by the following health-related policies. The following services are offered:

• Sudden illness or injury – Each injury and any subsequent medical treatment must be reported to the nurse as soon as it occurs. An accident report will be made out for any school-related injury requiring medical attention. If a student becomes ill during school hours, the student should report to the Health Office for proper evaluation and referral. Only the nurse can excuse a student from class in case of illness. A student may be excused to go home with parental permission. If the School Nurse is unable to reach a parent within 15 minutes, she will begin to call emergency contacts in order listed, to reach someone to take affected child home.
• Screenings – The School Nurse conducts vision, hearing and scoliosis screenings per the New York State guidelines, if not performed by your child’s personal health care provider.
• Counseling – Our health office staff is available for counseling on personal health matters.
• Physical education restriction – If a student is not to participate in Physical Education because of a health problem, a written excuse from a licensed health care provider is needed to give to Nurse Porter. A notification of the restriction will be given to the P.E. teacher(s) and sports coaches, if applicable. When the student is to return to P.E. class, proper documentation supporting medical release is required.
• Physicals/Health Appraisals: Education Law and Regulations of the Commissioner of Education require physical examinations of children when they:
  1. Enter the school district for the first time.
  2. Are in Pre-K or K, 1st, 3rd, 5th, 7th, 9th or 11th grade.
  3. Every year for students participating in interscholastic sports. (Sports physicals, see below)
  4. Need working papers. 
  5. Are referred by or to the Committee on Special Education.
  6. Are deemed necessary by school authorities to determine a child's education program.
• It is encouraged that a student’s own health care provider submit a physical/health appraisal form to the Nurse’s Office every year. However, at the times listed above it is mandatory, and needs to be submitted within 30 days of the start of the school year. If a report is not submitted, a school physical will be performed by the school’s medical director and Child Protective Services may be notified.
• Sports physical – Each student is required to have a sports physical prior to any participation in interscholastic sports. The sports physical is valid for a full calendar year with the exception of the student who has been absent from school for five or more consecutive days due to illness or who has sustained an injury. This student must be re-qualified by a licensed health care provider before returning to practice or competition, providing the absence or injury is relevant to sports participation. Proper documentation supporting medical release is required.
• Sports physicals are not being offered this year, please call 607-545-6421 ext. 2306 to discuss your options. Physical and sports questionnaires can be picked up in the Main Office, or outside the Nurse’s Office, or on the Health Office tab here on the CCSD website. 

 
Required Immunizations by Grade Level - Each student’s record will be evaluated for compliance with New York State Department of Health requirements.
Pre-K:

• Four doses of Diphtheria (DTaP)
• Three doses of Polio (OPV or IPV)
• One dose of Measles, Mumps, and Rubella (MMR)
• Three doses of the Hepatitis B Vaccine
• One dose of Varicella (chickenpox)
• One to Four doses of Haemophilus Influenzae Type b (Hib) - age specific
• One to Four doses of Pneumococcal Conjugate Vaccine (PCV) - age specific

Kindergarten - 5th grade:

• Three to Five doses of Diphtheria (DTaP) - age specific
• Three or Four doses of Polio (OPV or IPV) age specific
• Two doses of Measles, Mumps, and Rubella (MMR)
• Three doses of the Hepatitis B Vaccine
• Two doses of Varicella (chickenpox)

6th -11th grade:

• Three doses of Diphtheria (DTaP)
• One dose of Tetanus, Diphtheria and Pertussis Booster (Tdap)
• Three or Four doses of Polio (OPV or IPV) - age specific
• Two doses of Measles, Mumps, and Rubella (MMR)
• Three doses of the Hepatitis B Vaccine
• Two doses of Varicella (chickenpox)
• One dose of Menactra (meningococcal conjugate) - 7th grade and up

12th grade:

• Three doses of Diphtheria (DTaP)
• One dose of Tetanus, Diphtheria and Pertussis Booster (Tdap)
• Three of Polio (OPV or IPV)
• Two doses of Measles, Mumps, and Rubella (MMR)
• Three doses of the Hepatitis B Vaccine
• One dose of Varicella (chickenpox)
• Two doses of Menactra (meningococcal conjugate) *1 dose if given after age 16*

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Medication Policy – No student under any circumstances will be given any type of medication (including over-the-counter medications), unless the following guidelines are followed:

1. A written authorization form (white sheet with green bar across the top) signed by BOTH the prescriber and the parent/guardian with the following:
   1. Child's name
   2. Drug name and dosage with directions for administration
   3. Duration of time for medication to be used (for example; entire 2026-27 school year or for 1 full calendar year)
   4. Health Care Provider's signature and date 
2. The medication in the original bottle is to be labeled with child's name, delivered to the school by the parent or another responsible adult. Students cannot bring medication in to the Nurse’s Office themselves.
3. Students who have conditions that may require emergency medication or treatment should have a new statement (each year) on file at the school with a fresh supply of medication and an update on the condition and its treatment as described in #1.
4. Medication will be kept, locked securely, in the Nurse's Office unless the parent/guardian AND health care provider completes a self-medication form. This form must be kept on file in the Nurse’s Office. The medication MUST be kept in its original labeled container.

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If a student is found to have head lice or nits (lice eggs) at school, parents/guardians will be notified by the school nurse and provided information for lice/nit eradication steps. As it can be a socially delicate issue, families can decide whether to pick the student up (excused dismissal by nurse) or wait until the end of the day to begin the treatment process.