Student Medical Record Form

Health Center Hours of Operation

Monday - Friday: 7:30 a.m. to 7:30 p.m.
Saturday: 8:00 a.m. to 1:30 p.m.
Sunday: 9:30 a.m. to 1:30 p.m.
wendy.doyon@formanschool.org

The purpose of the Student Health Center (SHC) is to promote wellness, to provide counseling, and to provide supportive, not primary clinical care for students within the context of a school dispensary. The School's physicians hold clinic at the SHC two days per week and see students in their offices for special problems and procedures.

STUDENT PROTOCOL
Nursing staff will provide immediate care for bona fide emergencies; lesser problems will be scheduled for appointments later in the day. Students necessarily missing part of a class or other activity will be issued a time-stamped pass from a school nurse. Students who become ill during the afternoon must visit the SHC promptly so their needs can be tended to prior to the 7:30 p.m. closing of the SHC.

Students who are ill may not stay in the dorm or miss classes until they have been checked by the school nurse. The SHC will not respond to telephone calls received from students who are sick in the dormitory. Houseparents may request a dorm visit for a student who is extremely ill if the student cannot walk to the SHC without assistance. The SHC communicates each day’s list of sick students to the Dean’s Office.

Parents are responsible for all charges related to prescription medications, treatment, diagnostic tests, referrals and transportation for illnesses and injuries outside the scope of care rendered by the nursing staff at the campus dispensary. Students going to off-campus medical appointments are accompanied by an adult chaperone whenever possible. The chaperone will report to SHC as soon as possible to submit all medications and discharge documents.

During after-hours, the school utilizes the public services at Waterbury Hospital in Waterbury, CT: the Emergency Department (ED), the crisis intervention service and the walk-in clinic. In special cases, the Charlotte Hungerford Hospital in Torrington, CT, will be used because of its proximity to the School. The School physicians are on call continuously for the Health Center and the Administrator on Duty. Local 911 services or emergency drivers are used for transportation. Parents are notified of ED visits and other health concerns by Forman Administrators or Health Center staff as soon as possible. The telephone numbers of the SHC are 860-567-1821 and FAX 860-567-4692. If necessary, messages can be left on the SHC’s voice-mail.

Health care cannot be offered for overnights, extended illnesses, or severe problems. The School’s physicians will decide upon 23-hour hospital observation and/or admission. The School’s health team will determine the appropriateness for the return of any student who leaves the school for health problems. Students who are too ill to remain in the dorm, yet do not qualify for hospitalization, must return home.

Students who become ill or injured while at home or on vacation must likewise return healthy and be approved for return by the School’s physician. Students who leave for psychological treatment must be approved by the attending physician and the School’s consulting psychiatrist for return.

Students and parents are requested to schedule routine dental care and eye examinations during summers and vacations. Dental emergencies and orthodontic needs will be referred to the dentists designated by the school physician.

Medical Records / Medical Insurance
It is required that all medical authorizations and examination records are complete, without omissions, and updated. Current medical insurance information MUST BE ON FILE at the SHC before students are accepted into the School and at the start of each year. Students without valid medical Insurance will NOT be allowed to remain on campus at anytime, until adequate Insurance is obtained. International students may contact Independent School Medical Insurance (ISM), via http://www.isminc.com/. The Forman School cannot purchase or provide medical insurance coverage on your child’s behalf. If insurance coverage changes at any time, it is the parental responsibility to forward this information directly to SHC.

The SHC is not responsible for any expenses associated with failure to provide complete or updated insurance information.

Medications
Students who take medication must consider this a commitment of theirs and may not be allowed to remain at Forman if they do not take their medication as prescribed.

Medication Compliance
The School must act on the premise that medicine prescribed by doctors will help them be more successful at Forman. Students who refuse to take their medication as prescribed may not be allowed to remain in school. An accumulation of missed dosages will progress as follows:

• Conference with student and SHC staff;
• Conference with student, parent and SHC staff;
• Missed medications will result in a missed commitment;
• Request for on or off-campus medication evaluation;
• Review by the Assistant Head of School that may result in suspension from school;
• Possible dismissal from school.

Medications on Campus
All prescription medications must be mailed directly to the Student Health Center by the parent, or given directly to SHC staff. Prescription medication should NOT be sent with the student nor will it be dispensed (beyond the legal 24-hour travel dose) to the student for vacations. For reasons of quality control, controlled substances such as Ritalin, Concerta, Adderall, Dexedrine, Tylenol with Codeine and Fiorinal are not to be brought on campus by students or family members. Please have the prescribing physician send these prescriptions directly to the Student Health Center two weeks prior to arrival on campus, at which time it will be filled at Petricones Pharmacy in Torrington, CT, and made available to students on the opening day of school.

Other prescribed medications, which are not federally controlled, such as antidepressants, anti-anxiety agents, sleeping pills, antibiotics, allergy and asthma medications may be mailed directly to the SHC two weeks prior to arrival, in the original bottle labeled with the student’s name and current date. All medications must have the appropriate accompanying information on the medication authorization form regarding diagnosis and detailed administration information. All authorization forms require physician and parental signatures to allow administration of medication by SHC staff.

Parents are expected to maintain at-home supplies of medication for weekends and school vacations. Prescriptions authorized by parents who are physicians will not be accepted. Dosage schedules as written by the prescribing physician will be strictly adhered to by the School nurses.

Parents are not to change the typed label or instruct the nurses to administer the medication differently than that indicated by the prescribing physician. Any change in dose or frequency of medication may only come from the prescribing physician as a written order or faxed copy, followed by the original written order, via mail. The Student Health Center fax number 860-567-4692 comes directly and confidentially into the SHC. Medication authorization forms cannot be amended by anyone other than the prescribing physician. All medications accepted by the SHC will remain on campus until the end of the school year or separation from the School. All medications not retrieved by the end of the school year will be destroyed within three days unless communication is received requesting alternative arrangements. Medications cannot be held over for the following school year. Medications will not be sent home with students at the end of the school year. Parents requesting medications to be mailed home at any time during the school year will be responsible for the appropriate shipping costs.

In cases of allergic response, asthma, or contraceptives, students may be allowed to self-medicate ONLY with written permission of the prescribing physician. The Student Health Center will not be responsible to monitor or administer contraceptives. Except for asthma inhalers and bedtime medications given by houseparents, ALL medications will be administered by school nurses or designated assistants at mealtimes. Medications for simple aches, colds, flu etc. are available from the SHC. Students are not permitted to keep private supplies of non-prescription medicines in their rooms. Diet pills, diet drinks and muscle enhancement formulas are not allowed at The Forman School. Herbal remedies and dietary supplements are considered medications and are administered at mealtimes with routine medications. SHC staff will not accept verbal parental orders to administer herbal remedies. Herbal medications have medicinal properties, and therefore must have specific written instructions as to how your child is to take them. While the SHC recognizes and supports holistic treatments, we reserve the right to limit the administration of certain regimens, and may require both parental, physician or nutritional consultant signature to administer.

Each dormitory is equipped with a locked, first-aid and medication cabinet which the houseparents have access to for bedtime medications and supportive medical needs such as bandaids, Tylenol, thermometer and special personal medications, needed by students on a special need basis.

Medical Leave
Students leaving school or returning back to school for medical reasons must be cleared by the Health Center staff prior to leaving and upon returning. A doctor’s written statement must accompany the student’s return. He/she must also have an appointment with the School’s consulting medical staff. While academic work will be sent to a student during a medical leave, the maximum time the School can continue to support a student academically is three (3) weeks.

AIDS POLICY The best medical research to date indicates that a student with AIDS who is not sexually involved with others and whose blood does not come into contact with others does not pose a health risk. Medically, it appears that the risk of infection can be controlled and largely eliminated in normal school social situations. The School endeavors to educate the community both about the real and imaginary threats of this disease. Accordingly, The Forman School has adopted the following points of view toward AIDS:

• The best current medical evidence indicates that a person with AIDS or HIV infection does not pose a risk to the School community if there is an absence of sexual contact and blood is contained.
• Persons with AIDS or HIV infection are legally and morally protected from discrimination.
• The School will examine the case of an individual at Forman who is known to have AIDS and strive to protect his/her rights and health, while protecting others in the school community.
• It is vital that the School educate its students to understand the disease and the methods of its transmission, to help them achieve a rational perspective of its actual risks and to educate students to protect themselves from this disease.

Confidentiality
A student’s confidence will always be respected except when the health or safety of any individual may be in jeopardy or when the well-being of the School may be in danger.