Departments » Health Services & School Nurse
HEALTH SERVICES & SCHOOL NURSE
School Nurse - Sandra Hathaway, RN
315-852-3400, menu option 2
Click here for link to Family Health Network website
For students enrolled in Student Medical Services: A flu shot or mist is available for students enrolled in SMS. If interested, please stop in the SMS office to pick up a permission form.
New Student Health History Form
(PDF - 111 KB)
This form needs to be completed on every child as they enter DeRuyter Central School. Information provided will allow the school nurse to have medical knowledge of your child in order to provide the safest learning environment.
Health Appraisal or Physical Form
(PDF - 71 KB)
Current physicals are needed on any new entrant, students in grades Pre-kindergarten, Kindergarten, 2, 4, 7 and 10. To be completed by your child's primary health care provider. Although other forms may be acceptable, this is DeRuyter Central School official physical form.
(PDF - 28 KB)
Completed dental certificates are requested by the school nurse for every new entrant and students in grades Pre-kindergarten, Kindergarten, 2, 4, 7 and 10.
Medication Administration and Self-Carry/Self-Administer Medication Forms
(PDF - 93 KB)
This form needs to be completes for any and all medications that a student takes in school
Interval Health History Form
(PDF - 70 KB)
This form needs to be completed for all student/athletes prior to the beginning of each sports season, if the student has a current and complete sports physical that was not done within the 30 prior to the start of the season.
(PDF - 139 KB)
This form needs to be completed for all student/athletes at the time of their physical. The pre-particiation form is part of a complete sports physical.
||"pdf file: You need Adobe Acrobat Reader (version 5 or higher) to view this file. Download the free Adobe Acrobat Reader for PC or Macintosh."