Health Info for RETURNING Students 2019-2020
Please answer the following questions regarding your child. Please only complete this survey once per RETURNING student. (If you have any changes after submission, please email us at healthcenter@standrews-de.org.)
Email address *
Student Name (last name, first name) *
Your answer
Date of Birth (month/day/year - 2 digit format) *
Your answer
Expected Graduation Year *
Parent/Guardian name (first and last) completing this survey. *
Your answer
FLU VACCINE: Due to the global census of our school community, the School nurses offer and administer the flu (shot only) vaccine to students and faculty during each fall term under the direction of the School physician. Each year, we strive for a healthy campus and in order to ensure that, we highly recommend that all students receive the flu vaccine. (Please visit www.cdc.gov for the 2019/20 Influenza Vaccine Information Sheet.) *
POTASSIUM IODIDE TABLETS: SAS has developed an emergency plan in the unlikely event of an accident or incident at the Salem, New Jersey, nuclear power plan. Our plan involves preparations for both evacuation and on-site sheltering. Please visit the Health Center webpage for additional information. https://www.standrews-de.org/parents/health-center/potassium-iodide-information *
PRESCRIPTION & OVER-THE-COUNTER MEDICATIONS - Part I: All parents/guardians must review the following policy (which is also listed on our webpage) https://www.standrews-de.org/parents/health-center/school-medication-guidelines. *
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PRESCRIPTION & OVER-THE-COUNTER MEDICATIONS - Part II: All parents/guardians must review the following policy (which is also listed on our webpage). https://www.standrews-de.org/parents/health-center/school-medication-guidelines *
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MEDICAL HISTORY RECORD: The Health Center needs to know if your child has had any changes to his/her health since June 2018. *
TUBERCULOSIS (TB) RISK ASSESSMENT: Once we have received this information, we will confirm with you via email whether or not your child needs a PPD test, and/or Quantiferon Assay and/or Chest Xray. *
TB RISK ASSESSMENT: Did/will your child travel or reside outside the United States between September 2018 and August 2019? *
If you answered YES to the previous question, please provide the country/countries and the dates of travel.
Your answer
TB RISK ASSESSMENT: In the past year, has the student had close contact with anyone who was sick with TB? *
If you answered YES to the previous question, please provide details below.
Your answer
TB RISK ASSESSMENT: In the past year, has the student ever been a volunteer, employee or resident in a high-risk congregate setting such as a prison, nursing home, hospital, homeless shelter, residential facility or other health care facility? *
If you answer YES to the previous question, please provide us with details below.
Your answer
Thank you for completing Part I of the 2-step process. For Part II (due by June 30th), please be sure to download, print and complete the Health Forms on our website (https://www.standrews-de.org/parents/health-center)
A copy of your responses will be emailed to the address you provided.
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