rcs logo


Menu Trigger

Health Forms/Services

Health Forms

Mandatory Health Forms

Health Information Form
This form should be completed for all new students to Rochester Catholic Schools and those entering kindergarten, 3rd, 6th and 9th grades.

Optional Health Forms

Anaphylaxis Emergency Care Plan
This form gives the school authorization to administer epinephrine (e.g. EpiPen, Auvi-Q) to a child during an anaphylactic reaction (life-threatening allergic reaction) during the school day.

Authorization For Administration Of Medication
Complete this form if your child needs a medication given during school hours. A Health Care Provider’s signature is required for all prescription medications and for over-the-counter medications exceeding package recommendations. More information about medication administration at school can be found under Rochester Public Schools medication policy 516.

Diabetes Medical Management Plan
This form should be completed by the parent and reviewed with the Licensed School Nurse for a student with diabetes. An Authorization for Medication Administration Form or a written order signed by a physician for medications (e.g. insulin, glucagon) is also required. Parents are responsible to bring all diabetic supplies (e.g. test strips, meter, insulin, needles, syringe, glucagon, snacks, glucose tabs, ketone strips) to the health office prior to the beginning of the school year.

Diet Disability Plan
This form needs to be completed by your child's physician. It gives Rochester Catholic Schools Nutrition Services direction on appropriate meal substitutions for a child's special diet (e.g. food allergies that result in severe, life-threatening (anaphylactic) reactions).

Food Intolerances Allergies
This form provides guidelines for your child’s classroom and special area classrooms. If your child will be eating school meals and/or taking a beverage and will be needing substitutions due to a food intolerance or allergy, please contact your child's school front office.

Seizure Emergency Care Plan
This form should be completed for students that have a seizure disorder. If there is a seizure medication that will be kept at school, you will need a physician's signature.

Illness and Sending Your Child to School

Ordinarily we ask that children be sent to school even if they seem a little tired or irritable in the morning as long as they do not have any of the following signs or symptoms:

  • Temperature of 100º or more during the previous evening or night or in the morning.
  • Has vomited or had diarrhea during the night or in the morning.
  • Has a rash that may be caused by a disease or if the cause is unknown, check with your family physician before sending your child to school.
  • Until results of laboratory tests (i.e., throat culture, nasal swab) are known.
  • Children may return to school when:
    • Well enough to participate in normal school activities
    • Temperature remains normal for a 24-hour period without the use of fever reducing medications
    • Has not vomited or had diarrhea for a 24- hour period.
    • On an antibiotic for at least 24 hours OR your health care provider states your child can return to school.

If your child is at home sick, please call your school office daily to report the absence.


Stacey Goetz
Licensed School Nurse