Clinic Corner

Have we been trying to reach you? If you have a recent email or a voicemail from our Clinic, that means we DO NOT have the necessary forms for your student to start school for the 2024-2025 school year. Please contact us ASAP!

Clinic Reminders & Forms

Parents/Guardians who have School Action Forms and/or Medications to drop off must click here to schedule an appointment prior to the start of school with the clinic nurses, Carli Simpson and Kelly Jones.

Please review the following information and have your child’s health care provider(s) complete/sign forms as applicable and submit to the clinic prior to the start of the school year.

VA School Health Form & School Action Plan Downloads

• A health form is required for the following students:
• Students who are new to Saint Mary’s
• Kindergarten students
• 7th grade students (MenACWY and updated Tdap booster is required)
• Forms may be downloaded and printed from the Virginia Department of Health website.

If your child has Diabetes, Epilepsy, Asthma, or a Food Allergy or any medical condition that requires a school action plan, please fill out the appropriate form below or bring one provided by your child’s health care provider:

• Asthma Action Plan – This may be partially completed online, printed, and requires health care provider orders and their signature.You will need to make an appointment to drop off the form and your child’s medication.

• Allergy Management Plan – This may be completed online and printed, requires health care provider orders and signature. A photo of your child is also requested. Please make an appointment to drop off the action plan and your child’s medication(s).

• Diabetes Action Plan – Information and instructions on website. Please fill out the form and have a health care provider sign it. During your meeting with the nurses, we will discuss a full plan of care so allow a little longer meeting time. 
• Seizure Action Plan – Please have the form completely filled out and signed by the health care provider. You will need to make an appointment with the clinic to drop off the forms and rescue medication (if applicable). 

Medication Drop Off Policies & Form Download

• Please make an appointment with the clinic nurses to drop off ALL DAILY OR AS NEEDED MEDICATIONS to be administered to students of any age by the nurses during the school day. Virginia law and Diocesan requirements that allow clinic nurses to administer medications are very specific. It is important for the nurses to review that every healthcare provider order, parent/guardian signed form, and prescription bottle or over the counter unopened container meets the mandated state guidelines.
• All prescription and nonprescription medications (over the counter medications) require a health care provider signature on this form. Parents/guardians, must sign and date the form as well.
• Parents/guardians must hand deliver all prescription medications to the clinic in the original container/package, with the correct name, medication, dosage information. Expiration dates must be valid for the current school year. Medications not within these requirements will not be accepted.
• Parents/guardians must hand deliver all nonprescription medications to the clinic in the original, unopened container/package that is not expired. Medications not within these requirements will not be accepted.
• Students are not allowed to deliver the medications to the clinic.
• Students are never permitted to carry prescription or nonprescription medications on their person or in their backpack per school and diocesan policy unless they have prior authorization from the School Nurses.
• Students are never permitted to self-administer prescription medications or over the counter medications per school and diocesan policy unless they have prior authorization from the School Nurses.

WE ARE A NUT FREE CAMPUS

Please remember that our campus is NUT-FREE. This policy extends to snacks, lunches and special treats. Need suggestions? Contact our Clinic.