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Student Medical Forms & Concussion Protocol Forms

Tuesday, September 1, 2020
Wednesday, October 12, 2016
310
Monday, May 10, 2021

Student Medical Plan:

​A completed Student Medical Form (FORM A1420-1 attached) is required each school year, or when a medical need is identified, or when the student transfers to another school, in order to authorize the administration of prescribed medication to students who require it during school hours, or when the medication and/or dosage requirements change.
Specific to asthma, every student is now permitted to carry his or her asthma medication if the student has his or her parent’s or guardian’s permission.
Parents/guardians and adult students are responsible for ensuring that a current, completed Student Medical Form is on file at the school.  If the school is required to administer medications, medical forms must be signed by a physician.
Some students may experience severe life-threatening allergic reactions to bee, hornet, wasp or other flying insect stings or to certain foods or food ingredients such as peanuts. For students with life-threatening allergies, it is recommended that two doses of an epinephrine auto-injector are available on site at school.
Please do not hesitate to contact the school with any questions you may have.

FORM A1420 - 01 Student Medical Form.pdf

FORM A1420 - 02 Record of Administration of Medication-1.pdf

FORM A1420 - 06 Plan Of Care Anaphylaxis.pdf

FORM A1420 - 07 Plan Of Care Asthma.pdf

FORM A1420 - 08 Plan Of Care Diabetes.pdf

FORM A1420 - 09 Plan Of Care Epilepsy-1.pdf

FORM A1420 - 10 Plan Of Care Other Medical Conditions-1.pdf

Concussions:

If your son/daughter sustains a concussion - please alert the Main Office.  We will alert their teachers, guidance councillor and Vice Principal.  Please print the Concussion forms and have your medical practitioner fill out the assessment form / clearance form.  Bring the completed copy to the main office or email to Julie Burek at jburek@scdsb.on.ca.

A7216 Student Concussion Protocol.pdf

FORM A7216 - 1 Medical Concussion Assessment Form.pdf

FORM A7216 - 2 Concussion Management Plan for Return to School Plan and Return to Physical Activity Plan.pdf

FORM A7216 - 3 Concussion Medical Clearance Form.pdf


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