Annual Nurse Emergency Form and Other Health Information
Weston High School Health Services, 444 Wellesley Street, Weston, Massachusetts 02493
TO: Weston High School Parents/Guardians
SUBJECT: ANNUAL NURSE EMERGENCY FORM
The ANNUAL NURSE EMERGENCY FORM (click on it to download and print) must be completed for All students and returned to the High School Nurse before the start of school (please return to 444 Wellesley St. Weston MA 02493).
• Over-The-Counter Medications – this portion of the form must also be signed if you wish to give your child permission to receive over the counter medications (Tylenol, Advil, Benadryl, antacids, or generic equivalents).
Other over-the-counter medications (Excedrin, Pepto-Bismol, allergy preparations, etc.) require a doctor’s order and parent/guardian consent forms (all forms can be found by clicking here).
• Prescribed Medications – if your child will be taking any prescribed medication during school hours, using diabetes supplies, or has been prescribed an Epi-Pen, Auvi-Q or asthma inhaler, we will need the following forms completed and returned to the High School Nurse’s office before the start of the school (all forms can be found by clicking here):
- Parent/Guardian Consent for Medication Administration
- Health Care Provider’s Medication Order completed and signed by the licensed prescriber
- Student Asthma Action Plan and/or Epi-Pen Plan (if applicable)
- Diabetes Care Plan (if applicable, or a copy supplied by the care provider)
At the High School level, we encourage students to carry their own inhalers, Epi-Pens and diabetes supplies. However, in accordance with Weston Public Schools Policy and Massachusetts Department of Public Health regulations, we must still have these forms on file in the Nurse’s Office as well. If you wish, we can keep back-up supplies here.
PLEASE RETURN COMPLETED PAPERWORK TO THE HIGH SCHOOL NURSE’S OFFICE BEFORE THE START OF SCHOOL (address below). Medications should be delivered by a parent/guardian in a pharmacy or manufacturer labeled container. Please do not send more than a 30-day supply.
**Please note: these forms are not related to any that must be completed for sports participation, such as: Family ID, Athletic Trainer SportsWare, or the annual physical examination.**
Thank you for your assistance.
Michelle Rizza, RN
Weston High School Nurse
444 Wellesley Street
Weston, MA 02493
Phone: 781-786-5837
Forms are available by visiting westonschools.org. → District → Administration → Health Services-Health Forms and Publications
