Health Suite/Health Forms

Health Forms

All NEW incoming students and all incoming SIXTH GRADE students are required to submit the following forms prior to school entry:

  • A Health Assessment Form.  Part I is to be filled out by the parent/guardian.  Part II must be filled out by the healthcare provider (Physician/Nurse Practitioner), and be signed and dated.
  • An Immunization Form (DHMH 896), must be filled out by the health care provider (or a computerized record may be attached). We abide by the State of Maryland Immunization requirements.
  • Health Allergy Action Form for any student with allergies that may require epinephrine or antihistamine.
  • Medication Administration Form for anyone requiring ANY prescription medication to be given at school. This form must be filled out and signed by a doctor and the parent.
  • Over the Counter Medication Form for anyone requiring ANY non-prescription medication to be given at the school. (This includes Tylenol, Ibuprofen, Benadryl, Neosporin, eye drops, or any other OTC medications). This form should be filled out at the beginning of the school year and placed on file for that year.
  • Discontinuation of Prescription Medication Form for any student that no longer requires prescription medication. 

Please submit these forms no later than August 1, 2020. Students will not be admitted to school without completed forms.

Please Note:

As of September 4, 2018, The Sacred Heart School of  Glyndon has adopted a policy allowing the availability of stock epinephrine in the health suite for use in the event of an anaphylactic emergency. This epinephrine is for emergency use during normal school days and is not dependent on allergy history. It is not available outside of normal school hours or on field trips. Students with a known history of severe allergies are still expected to maintain emergency action plans, medical orders, and their own supply of emergency medication.

Statement of Authorization to Obtain and Store Auto-injectable Epinephrine

In order to establish this policy and procedure, The Sacred Heart School of Glyndon, in accordance with its rules of governance, has authorized the school nurse or other licensed health care practitioner to obtain and store auto-injectable epinephrine to be used in an emergency situation.

The Sacred Heart School of Glyndon stocks both .15 mg and .30 mg doses of auto-injectable epinephrine in an unlocked cabinet available during the regular school day. This epinephrine will not be sent on field trips or be available outside of regular school hours. Emergency stock epinephrine is available during the school day to all students, staff, and school visitors regardless of their history of anaphylaxis. It is expected that individuals who have a known history of severe allergies continue to obtain individual medical orders, maintain an individual supply of emergency medications, and follow the school’s procedures for students at risk for an anaphylactic reaction.

Snack Policy

Any food that is shared with other students must be completely nut-free (cannot contain peanut or tree nut) and must not be processed in a facility that processes any kinds of nuts. All outside food brought in for a party/celebration must be checked by the nurse before going to the classroom or cafeteria. Please note that items from Dunkin Donuts are NOT allowed as they either contain nuts or are made in a facility that processes nuts.

Please contact the nurse on duty at any time with questions or concerns.