Health Services Info & Forms
Dear New and Returning Darrow School Families, Below are the Darrow Health forms which must be completed for all students, new and returning, who enter Darrow School by the time of registration. The forms should be read carefully and be filled out completely and accurately. Also attached you will find a doctor’s order form that must be filled out and signed by the doctor for any prescription medications your child will be taking while at school.
Specific areas of the form which we feel should be reinforced are as follows: 1. Personal Information: Please note full addresses and all telephone numbers where you may be reached in the event of an emergency.
2. Permission: The permission form is required by all emergency care facilities before treatment will be given and is mandatory for enrollment. Once you have filled in the top portion, please be sure to sign at the bottom. 3. Insurance Information: See back of Permission to Treat Form for instructions. We require that all students (foreign and domestic) carry health insurance, as emergency and urgent medical care can be extremely costly without insurance coverage. If you have insurance cards, please make copies of these cards and attach to the form. If you are unable to make copies of your cards at home, please bring the cards with you to registration and we will make copies for you. If you are purchasing the Darrow health insurance policy for your child, please indicate this on the form and we will enter the ID# once it has been assigned. **Please remember to send us updates and/or changes of insurance/billing information during the school year.
4. Physical examination and screening: The doctor must sign and fill out this page foryour child to be allowed to participate in team sports activities per New York State law and in non-team sports per Darrow School Policy. This exam must be done yearly. This needs to be done prior to registration.
5. Immunizations: New York State enforces laws which refuse enrollment of any child who fails to comply with the immunization requirements. Please be sure that all of your child’s immunizations have been recorded, or that blood tests have been performed to prove immunity. If your child is not immunized due to medical or religious exemption please indicate this on page 2 of form and sign. If we do not have your child’s complete immunization record in hand by registration your child will not be considered registered and will return home with you until we have the records. **New as of Fall 2003: New York State requires all residential schools to provide information regarding meningitis vaccination to parents and students. Attached to the immunization record you will find information about meningitis and vaccination. At this time the vaccination is not required, but highly recommended. If after reading the information you decide not to have your child vaccinated for meningitis, please check the appropriate response block on the immunization form (Part II.) 6. Health History: Please fill out the medical history side of the physical form as accurately and completely as possible. When portions of your child’s health history are left off these records it is difficult for Darrow Health Services and area health providers to provide the best possible care for your child. If there is any relevant parental health history that our school physician should know, please include it on the form and designate which parent it applies to.
Darrow School is affiliated with pediatrician Dr. Vicki Smith’s office, located at 374 South Street, Pittsfield, MA 01201, for urgent care visits and consultation. Her phone number is 413-447-3888. If your child is seen by Dr. Smith or one of her associates, your insurance information will be forwarded to their office. If you have co-pays or deductibles associated with your insurance, please notify Health Services staff if you would like these payments withdrawn from your child’s student drawing account.
If your child has prescriptions that will need to be filled/refilled while at school, we use Big Y Pharmacy in Pittsfield (413-447-9844). They participate with most prescription plans. Co-pays/payments from the pharmacy are deducted from the student’s drawing account at the end of each month. Please note that you should not send over the counter medications to school with your child. Health Services is stocked with common over the counter preparations and it is against school policy to allow students to keep any type of medication or vitamins in their room. There are a few exceptions to this such as asthma inhalers, skin ointments, eye drops and prescription allergy nose sprays. These medications need to be registered with the nurse. All medications should be brought to Health Services during registration. If you will be sending medication to school for your child via a mail service, you must address it to Health Services and not your child. During the school year, please also note that controlled substances that are prescribed for your child will not be allowed to be released to them for travel to/from vacations or otherwise. If your child will need these medications when away from school, a parent/guardian can pick them up from Health Services before leaving campus or we can overnight mail them to a parent/guardian with prior notice.
Please forward the enclosed forms to my attention at Darrow School as soon as possible and prior to registration. They can be sent via mail or fax (518) 794-6024. If you are unable to get the forms completed until just prior to traveling to school, please bring them with you and we will review them at registration. Doctor’s offices that are mailing the completed forms directly to us should write a brief note as to when they will be mailing the forms for your child and that note presented at registration as proof of process in case forms are not returned to us by registration day.
If you have any questions about the above information, please feel free to contact me via phone or email (preferred through summer months). I look forward to seeing you in September!
Sincerely,
Crysta Ryan, RN
Darrow School Health Services
(518) 794-6013-phone
(518) 794-6024-fax
ryanc@darrowschool.org
