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School Nurse:  Ana McGurn

For any nursing related questions, please call the office at (740) 275-4326.

Required Medical Forms

Emergency Medical/ Transportation Authorization Form [Download PDF]
Medication Request Form [Download PDF]

EMERGENCY MEDICAL/TRANSPORTATION AUTHORIZATION FORM
Each parent must complete an emergency medical authorization form upon the child’s enrollment.  This form is to be kept at the school office as record of the student’s home phone number, parents’ employment numbers, family or friend’s numbers, physician number, dentist number, and signature indicating permission to contact a licensed physician if own is not available.  This MUST be on file by the first week of school.

IMMUNIZATION POLICY
Immunization Records: Students enrolling in JCCS must meet current state immunization requirements and submit records OR show a written statement from the physician stating that immunizations were withheld due to medical reasons OR an official exemption document if immunizations were withheld for personal/religious reasons.

Failure to meet one of the above criteria will result in the student being excluded from school until such requirement is met. 

Ohio Department of Health Immunization Program by Grade [Download PDF]
Immunization Summary for School Attendance [Download PDF]

SCREENINGS
Speech, vision, and hearing screenings will take place each year in Grades K, 1, 3, 5, 7, 9, and for all new students through the months of August and September.  If difficulties are suspected, parents will be notified and referred to the proper professional and/or our speech therapist.  If speech therapy is recommended, parents will be notified and permission obtained prior to placement. Scoliosis and BMI screenings are also given yearly.  Parents must contact the office if they do not wish for their student(s) to be screened.

MEDICATION
The State of Ohio requires a form to be signed by both physician & parent/guardian in order for your child to take ANY medication at school whether prescription or over-the-counter.

We strongly encourage that, whenever possible, the timing of taking medications be scheduled so that they can be taken at home.  Only when no other arrangements can be made will it be acceptable for them to be taken at school.

If it is necessary for your child to be given a medication at school, the following requirements must be met:

  1. Written request signed by the physician and parent/guardian for each and all prescription and non-prescription medications. The Medication Request Form must include the dosage to be given, the time the medication is to be given, and the route of administration.
  2. A separate form must be filled out for each medication.

NO student is to have medication in his possession at school.  Medications (both prescribed and non-prescribed) must be kept in the school office.  For this reason, no medication should ever be passed from one student to another.  If this should happen, the students involved will be subjected to disciplinary action.  The only exception to this is that students may keep prescribed inhalers or “epi-pens” on their person to self-administer these medications as needed as long as written documentation is on file as outlined below.

NO medications will be given without completion of the forms above.

All medications must be sent to school in the original container that must be properly labeled with the student’s name, name of the medication, dosage of medication to be given, and the time medication is to be given.

It will be the student’s responsibility to come to the office for self-administration of medication that will be taken in the presence of school personnel.  Our staff will do their best to remind the younger children to report to the office to receive their medication at the proper time.

Should there be any change in the administration of the medication, notification is to be sent to the secretary in writing on the proper form signed by a physician.

The school will assume no responsibility for
liability in association with administration of medications at school.