Massachusetts Department of Public Health (MDPH) and the Center for Disease Control (CDC), require the following health information to be on file in the school Health Office for all foreign born students entering and attending secondary school (Gr. 9-12) in Massachusetts. All information must be submitted in the English language.
1. Current Physical examination (within past 6 months)
2. Immunizations:
DTP or DTaP 4 Doses
Tdap 1 Dose
Polio 3 Doses
MMR 2 Doses (1st must be after 12 months of age)
Hepatitis B 3 Doses
Varicella 2 Doses
TB- PPD-YEARLY (IF POSITIVE, CHEST X-RAY REQUIRED)
Athletes are required to have a yearly physical exam on file in the Health Office for medical clearance to participate.
This information must be in the Arlington Catholic Health Office by August 1st.
PART A- this section should be filled out by a parent. Please include any Medical Concerns/ Conditions or Medications that the Nurse, Guidance Counselor or Teachers should be aware of.
PART B- ACHS physical exam form may be used by the Physician or they may prefer to use their own copy of the physical exam from their practice.
Medication Permission Form must be completed in order for certain medications to be dispensed during the school day. Please check off medications on this form to be dispensed if needed during the school year and sign the permission form. This form must be updated yearly.
PLEASE Note any MEDICATION/ FOOD ALLERGIES on this form.
Prescribed Medications (if needed) to be taken during the day must have the order signed by the Physician. A copy of this order must be on file in the Health Office.
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