"The Blue Form" revised 4/2011
***NOTE: The above State of Connecticut Health Assessment Record replaces the Sports Physical Examination and Pre-Participation Form.
Prescription and NON-Prescription
Medication Policy and Administration for the Medicines Form
In compliance with the Connecticut State Law and regulations, the Simsbury Board of Education requires a physician's authorization for a nurse to administer medication in school. Medication must be in a pharmacy prepared container, or the original container and brought to school by the parent/guardian. It must be labeled with the name of the child, the name of the drug, the strength, dosage, and frequency, along with the physician's or dentist's name.
The form on the reverse side of this policy must be completed by the physician or dentist ordering the medicine and by the parent/guardian.
When a prescription is taken to the pharmacy and the medication is needed for school, please ask the pharmacist for a school container as well as a container for home. The pharmacist will supply a second container for administration of medicine in school.
Please remember that all medication must be brought to school by the parent/guardian and delivered only to the school nurse. It must be picked up in the same manner; otherwise, it will be discarded. Any medication received in a non-pharmaceutical container will not be administered.
Health Entrance Requirements/Physical Examination Requirements
2012-2013 Immunization Requirements for Newly Enrolled Students at Connecticut Schools
If you have any questions on immunization requirements, please do not hesitate to contact your school nurse.
Physician’s Initial Medical Questionnaire for Academic Planning