MEDICAL PROFILE AND INFORMATION To be completed for all new students. Please print, complete, sign and return to Registrar’s Office.
Student’s name: __________________________________Year level in 2012:___________
Section 1 (to be completed by parents)
Please tick which immunisations your child
(Please tick if appropriate and provide full details)
Does your child suffer from any of the following?
(Give details of any special care recommended by parent or student ’s doctor)
Does your child have any other physical limitations or medical conditions?
Is your child allergic to any drugs or foodstuffs?
administration of medication during school
(If yes, please ensure medication is clearly labeled with studedosage and instructions as per treating medical doctor) MEDICAL PROFILE AND INFORMATION To be completed for all new students. Please print, complete, sign and return to Registrar’s Office.
All students commencing at St Leonard's College are requested to undertake a general physical examination in order to ensure that any health issues that may affect their education are identified so that the College can assist them with their individual needs. Please ask your family doctor to complete the following information (where age appropriate). Student’s name: __________________________________ Year level in 2012:___________
Section 2 (to be completed by the family doctor) Asthma management (if applicable)
Has the child suffered sudden severe asthma attacks?
Has the child been admitted to hospital due to asthma in the past year?
Has the child been on oral cortisone for asthma within the past year?
Please provide asthma management plan as prescribed
I give permission for a staff member to administer ventolin if my child
Any additional comments – please give details of allergies
Parent's / guardian's signature: ________________________________ Date: ___________ AUTHORISATION FOR NURSING STAFF TO ADMINISTER NON-PRESCRIPTION OR OVER THE COUNTER MEDICATION/CREAMS
To be completed for all new students. Please print, complete, sign and return to Registrar’s Office.
Student’s name: __________________________________ Year level in 2012:____________
The following non-prescription or 'over the counter' medications are held in the Health Centre for the relief of minor illnesses. Please tick EACH medication you authorise the Registered Nursing Staff to administer to your son/daughter if required. MEDICATION authorised
Cough mixtures (expectorants & suppressants)
Parent's / guardian's signature: _________________________________________________
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