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School Based Health Clinic
COVID Information
Physical and Immunization Information
Nurse Contact Information
Nurse Forms
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Torrington Middle School
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Departments
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Nurses' Office
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Nurse Forms
Nurse Forms
CT Blue Form (Physical Assessment):
https://portal.ct.gov/-/media/SDE/School-Nursing/Forms/HAR3.pdf
Medication Authorization form:
* one medication per form
* parent/guardian and doctor must sign form
*
NO
medications can be given in school without a completed medication authorization form
*children can ONLY self carry inhalers and Epi Pens
Medication Authorization Form-- English
Medication Authorization Spanish.docx
Care Plans:
1. FARE Food Allergy English and Spanish.pdf
2. Asthma English and Spanish 0-11 yrs.pdf
3. Asthma English and Spanish 12 yrs +.pdf
4.
Seizure Care Plan--English
5.
Seizure Care Plan--Spanish
* Nurse can make personalized care plans with student photos as well
HIPAA:
1.
HIPAA Blank form for TMS.docx
2.
HIPAA Blank form for TMS - Spanish.docx
3.
HIPAA Blank form for CCMC students.pd
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