BYRAM HEALTH OFFICES

Dear Parents/Guardians:

Enclosed is the Health Care Plans which helps us plan for the health needs of your child at school and school related activities. We would appreciate your prompt return of the completed plan to the Health Office.

Please ask your physician to review and sign the care plan after you complete it. Include one picture of your child on the care plan and, if your child is to receive medicine at school, one picture on the medication.

Please contact your school nurse to arrange for a meeting to discuss your child’s special needs at school so that they can be put in place at the start of school. Messages can be left with the school secretaries or e-mails can be sent during the summer.

Please follow the medication policy that is sent home in September and is also in the school calendar. Teachers and coaches cannot give medications. If your child needs to carry an inhaler or EpiPen for emergency use, please call your school nurse for more information.

We look forward to helping your child have a successful school year and please do not hesitate to call your school nurse for any questions or concerns. We have found that good communication really is a key to success.

Sincerely yours,

Lorie Miller, School Nurse

Intermediate School

973-347-1047 ex. 2103

Barbara Scholl, School Nurse

Byram Lakes Elementary

973-347-1019 ex. 2404

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HEALTH CARE & EMERGENCY PLAN

               [Place picture here]

Student’s Name: _________________________________________

Grade: _______ Teacher: ______________________________

Other information: SEE EMERGENCY CARD

Health Needs Information:

Health Need: _________________________________________________________

_________________________________________________________

Trigger/Cause of Need (bee sting, food intake, upper respiratory infection (cold), etc.)

_____________________________________________________________________

Signs and Symptoms of Health Need: _______________________________________

______________________________________________________________________

Medications: (If medication needed at school or activities at school, please see medication policy in school calendar. Coaches and advisors cannot give medications.)

______________________________________________________________________

______________________________________________________________________

Side Affects to watch for: _________________________________________________

______________________________________________________________________

Treatments and Special Equipment needed:___________________________________

______________________________________________________________________

Any Additional Accommodations needed:

_________________________________________

______________________________________________________________________

Health Needs Plan

Please explain what your child’s health needs will be for school and related activities, i.e.

classroom, lunch, recess, trips, after school activities, sports, bus to and from school.

_______________________________________________________________________

_______________________________________________________________________

Bus # to School______________________ Bus # from school__________________

EMERGENCY PLAN

If my child has an emergency, it will be_______________________________________

_______________________________________________________________________

Do the following_________________________________________________________

_______________________________________________________________________

See Emergency card for necessary contacts and phone #s

PARENTAL PERMISSION TO SHARE CHILD’S HEALTH NEEDS

I have provided this information to plan for the health needs of my child at school and all related school activities and on the school bus.

I give permission for this information to be shared with the school staff, cafeteria staff and bus drivers who will be with my child during the school day.

Parent Signature__________________________________________________________

Physician Review: I have reviewed and agree with this School Health Needs Plan for

___________________________________. Additional Comments_________________

_______________________________________________________________________

Physician Signature/Date___________________________________________________