Health Forms

Dear New Families,

Welcome to St. Michael’s!  We are looking forward to having you join our community.  

As we welcome you into our fold, I hope this letter will help to simplify the health documents that are required for students before the start of each school year.  Below is a link for each form with a small explanation of who needs to complete the form and whether or not you will need to obtain a physician’s signature.

WHEN AND HOW TO SUBMIT FORMS:

Please submit all forms in hard copy (NO electronic submissions please), by early August if possible, and no later than the end of the week BEFORE school starts.  

If your child has any chronic health conditions that will need regular monitoring and support in school, please call or email me at your earliest convenience.  This will help to ensure that all of the pertinent information is exchanged, to make your child’s school experience as safe and equitable within our community, as possible.

What if you are coming from out-of-state or country?

Please download the RI State Physical Exam Record offered below, and bring it to your child’s current primary care physician for completion.  Immunization records can be attached (they do not have to be filled in on the sheet).  If it is not possible to have a doctor complete this form before you come, please bring a copy of your child’s most recent exam paperwork addressing all of the information requested in our Rhode Island form.  Physical Exam Records are current for 12 months.

FORMS TO COMPLETE AND SUBMIT: 

CLICK HERE for AUTHORIZATION FOR EMERGENCY MEDICAL AND/OR SURGICAL TREATMENT AND RELEASE

CLICK HERE for RI PHYSICAL EXAM RECORD FORM  

• This form is to be signed by a physician and include full immunization record
• Immunization records may be attached separately
• If your child is NOT fully vaccinated, speak with your doctor to obtain the appropriate exemption forms.  These forms must be renewed annually and submitted prior to the start of school
• *** Please note additional requirements prior to Kindergarten entry: 
  • students must provide documentation of a vision exam provided by either their pediatrician, an ophthalmologist, or optometrist
  • Completion of Lead screening
• For further information regarding required immunizations: 
  • CLICK HERE to access the State of RI Immunization Office.  

CLICK HERE for the ANNUAL STUDENT HEALTH HISTORY FORM

• This form is to be filled in completely and signed by parent/guardian  
• One form for each child submitted annually

ONLY COMPLETE IF:

• Your child has a SEVERE Allergy:
  • CLICK HERE for FOOD ALLERGY EMERGENCY ACTION PLAN
  • This form must be completed and signed by a provider AND parent/guardian
  • Physician to include in the order whether or NOT (depending on age/developmental appropriateness) your child has permission to self carry and/or administer medication and your signature indicates that parent concurs 
  • Self carry/administer permissions are specifically important for field trips. At school RN is available for administration and teachers are trained in emergency EPI pen administration annually

• Your child has a diagnosis of ASTHMA
  • CLICK HERE for ASTHMA ACTION PLAN 
  • This form must be completed and signed by a provider AND parent/guardian
  • Physician to include in the order whether or NOT (depending on age/developmental appropriateness) your child has permission to self carry and/or administer medication and your signature indicates that parent concurs.
  • Self carry/administer permissions are specifically important for field trips. At school RN is available for administration

• If your child will need to receive medication at school, prescription, and/or over-the-counter 
  • CLICK HERE for the MEDICATION ORDERS & CONSENT
  • This form has three parts including parental consent (signature required), physician orders (signature required), and importantly, parent and physician allowance for student self administration during field trips. 

Thank you very much for your attention to these details.  Please do not hesitate to contact me directly with any questions or concerns: 

Megan Buchanan BSN, RN
mbuchanan@smcds.org
(401) 849-5970 ext. 389

I look forward to meeting you!

Sincerely,
Megan Buchanan

Please submit this signed form to your child’s previous school so that St. Michael’s Country Day School may receive your child’s official records. If you have any questions, please contact Sandy Merten, Director of Enrollment, at smerten@smcds.org.