Medical Forms 2011-2012

Printable Medical Forms
BACS Medical Forms by Grade
BACS Medical Form Explanation

May 2, 2011

Dear Parents,

Included in this page are the medical forms needed for you child(ren) for the 2011-2012 school year. Please return ALL the appropriate  forms by July 15, 2011. This allows time for processing and helps us anticipate student needs to make BACS a safe and healthy environment for your child(ren). 

The immunization requirements for the state of Pennsylvania have changed for the 2011-2012 school year. Please review the list of required immunizations below to make sure your child is up to date. In light of these changes, an updated immunization status is required for ALL students at BACS. Pennsylvania still allows for a religious exemption (or strong moral or ethical conviction similar to a religious belief). A signed statement of religious exemption must be on file at BACS for all students who have not fulfilled the vaccine requirements. In the event of an outbreak of a vaccine preventable disease, a child may be excluded at the recommendation of the Health Department for the duration of the outbreak.

We have been more lenient in the past around the timeliness of medical forms. We will be tightening up in this area in order to comply with Pennsylvania Code 23 which requires that ALL forms be submitted prior to the first day of school. We are requesting that parents do their best to return their forms by July 15th, 2011. If you are unable to get a medical or dental appointment prior to the first day of school, you must submit to BACS, the most current dental/physical form on file at your doctor/dentist’s office and the date of your child’s scheduled appointment. An updated form must be submitted immediately following your child’s appointment. (Sports physicals are only required for those students who wish to participate in the Extra PE program. Sports physicals that are more than 1 year old can not be accepted for clearance to participate in extra PE). Your child(ren) will not be permitted to start school on August 30th, 2011 if their forms have not been received. We suggest you make your appointments early as summer appointments tend to fill quickly.

Extra copies of forms and an explanation of each form are available below and the school office. (A summary of required forms for each grade are available below).

Thank you in advance. Please feel free to contact us with any questions.

Kathy McQueen, RN BSN                                            Dr. Reid Prichett
215-947-4086 x225
Kathy.mcqueen@bacs-gc.org

Printable Medical Forms

BACS Medical Forms by Grade

Kindergarten and All New Students: Student Health History/Release of Information, Standing Orders for Medications, Physical Examination and Dental Examination

It is a Pennsylvania state law that children entering Kindergarten (and all new students) must have a physical and dental examination (filled out and signed by doctor/dentist).

1st grade: Returning Student Health History/Release of Information, Standing Orders for Medication

2nd grade: Returning Student Health History/Release of Information, Standing Orders for Medication

3rd grade: Returning Student Health History/Release of Information, Standing Orders for Medication, Dental Examination

It is a Pennsylvania state law that children entering 3rd grade have a dental examination (filled out and signed by dentist).

4th grade: Returning Student Health History/Release of Information, Standing Orders for Medication

5th grade: Returning Student Health History/Release of Information, Standing Orders for Medication, *Sports Physical Examination

*It is a BACS requirement that all students who wish to participate in the Extra PE program have a sports physical examination (filled out and signed by doctor).

6th grade: Returning Student Health History/Release of Information, Standing Orders for Medication, Physical Examination, *Sports Physical Examination

It is a Pennsylvania state law that children entering 6th grade have a physical examination. *It is a BACS requirement that all children who wish to participate in the Extra PE program have a sports physical examination. (The combined form covers both physicals – filled out and signed by the doctor).

7th grade: Returning Student Health History/Release of Information, Standing Orders for Medication, *Sports Physical Examination

It is a Pennsylvania state law that children entering 7th grade have a dental examination (filled out and signed by the dentist). *It is a BACS requirement that all students who wish to participate in the Extra PE program have a sports physical examination (filled out and signed by the doctor).

8th grade: Returning Student Health History/Release of Information, Standing Orders for Medication, *Sports Physical Examination

*It is a BACS requirement that all students who wish to participate in the Extra PE program have a sports physical examination (filled out and signed by the doctor).

BACS Medical Forms Explanation

The Private Physician’s Report and Private Dentist Report are Pennsylvania state requirements for specific grade levels. The Private Physician Report must be filled out and signed by your child’s doctor. The Private Dentist report must be filled out and signed by your child’s dentist.

The Sports Physical Evaluation is required for all students, 5th – 8th grade, who want to participate in the Extra PE program. This form must be filled out and signed by your child’s doctor and is good for the entire school year. Students entering 6th grade can have the doctor fill out the “Sports Examination and Clearance for Sports Participation” section of the Private Physician’s Report of Physical Examination, rather than the separate Sports Physical Evaluation. (This combined form covers both requirements). Students who do not have a sports clearance on file will not be allowed to play.

The Student Health History Form and Release of Information, to be filled out by the parents, helps to provide a more complete picture of your child’s health and allows us to better provide for his/her health needs. Complete Student Health History Forms need to be submitted for all new students. Returning students can fill out the “update” form.

The Standing Orders for Medications at BACS form covers the use of over the counter medications (and Epi-pens) at school. You may pick and choose which (if any) medications you would like your child(ren) to have access to at school. Please return a form for each child even if you do not want them to receive any medication while at school – this will save both of us a phone call should the issue arise. Please contact the school nurse if you have a child that requires prescription medication while at school.

The Statement of Exemption to Immunization card is enclosed for new parents who might want to choose this option. These cards are available to other parents upon request.