- Terrill Middle School
- Health Information and Forms
Nurses
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Universal Child Health Record
A current physical (within one year of registering ) is required for new students registering from another state or country. A student registering from another district in New Jersey must provide a copy of a physical. A copy of current immunizations is required of all new students.
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EPI PEN Order Form
Use this form if your child has significant allergic reactions. Parent/Guardian must bring the medication and Physician's orders to the nurse. An adult must pick up the medication at the end of the school year, or it will be discarded. If your child has been trained to self administer his medication, he/she may pick up their medication at the end of the school year. New orders are needed each school year.
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Asthma Treatment Plan
Asthma Management In School: New Jersey law requires students with asthma to have an Asthma Treatment Plan on file with the School Nurse. Please use this form should your child require an inhaler or nebulizer treatment in school.
In order for students to self-carry their inhaler in school, your Health Care Provider must check off the approval at the bottom of the Asthma Treatment Plan. Every child with Asthma needs to have a personalized asthma action plan meeting NJ law whether they self carry an inhaler or not. Kindly have the physician complete, parental signatures are also required. Please give medication to the school nurse in the original labeled medication box, and note the expiration date replacing as needed. If your child does not self-carry their inhaler, the medication must be picked up at the end of the school year, otherwise this will need to be discarded.