Administration for Child's Services
Anaphylaxis Services in School
- Adrenaclick Epinephrine Skills Checklist
- Anaphylaxis Individualized Healthcare Plan (IHP)
- Anaphylaxis & Administration Training for School Personnel
- Auvi-Q Checklist
- Chancellors Regulation A-715
- Epinephrine Auto-Injector Use, and Training Memo
- Epinephrine Skills Checklist
- Epi-Pen and Mylan Epinephrine Auto-Injector Skills Checklist
- Impax Epinephrine Auto-Injector Skills Checklist
- Non-Patient Specific Standing Order for Epinephrine 2024
- Symjepi Epinephrine Injection Skills Checklist
- Teva Epipen Facts Sheet
- Teva Generic Epinephrine Auto-Injector Skills Checklist
After School and Extended Day Coverage
Everything you need to know about vacancies and requesting a transfer or extended day coverage.
- After School Vacancy List
- Memo on After School Vacancy Requests
- After School Program Vacancy Request Form
- Request Form for Extended Day Nursing Coverage
- Clarification regarding approvals for nursing coverage
- Guidance on DOE Student After-School/Extracurricular Para & Nursing Requests
- Memo on Extended Day Coverage
Asthma Services at School
- HFA Maintenance Form
- Re-order Form for Ventolin, Flovent, Spacer, Epi-pen, Auvi-Q
- Stock Albuterol Policy and Procedure
- Stock Ventolin HFA Maintenance
- EASI Protocol (Updated October 2023)
- Stock Ventolin Policy and Procedure
- School Asthma Questionnaire
- Suspected Asthma Letter
- New HFA Inhaler Instructions
- Open Airways for Schools Administrator Guide
- Open Airways for Schools Implementation Roadmap
- Open Airways for Schools Internal Roster FY25
- Open Airways for Schools Materials and Cinch Bag Form
- Open Airways for Schools Parent Permission Letter
- Open Airways for Schools Pre/Post Program Questionnaire
Child Adolescent Health Examination Form
Concussion Management
- Head Injury Notification Form
Dental Services at School
- Dental Resources for School Nurses
- Daily Student Form Dental Services
- Dental Referral Form
- School-based Dental Provider List
Diabetes Services at School
- Diabetes Documentation Form
- DMAF Fax Sheet
- Training of Unlicensed Individuals in the Injection of Glucagon in Emergency Situations
- Diabetes Safety Protocol
- Diabetes Team Field Support Process
- Diabetes Team Support Request Form
Healthy Options and Physical Activity in Schools
Medication Administration Forms
Please see the Health Forms and Notices page for all MAFs.
Medical Room Standardization
- School Contact Numbers
- School Information Sheet
- Medical Room Standardization
- Emergency Bag Contents
- Preparation Guide for Covering Nurses
- Covering Nurse Form
Medication Services at School
Please see the Health Forms and Notices page for all MAFs.
- Components of the Medication Binder
- Controlled Substance Count Sheet
- Cover Sheet for Amended Special Health Services
- Disposal of Medication in Office of School Health Setting
- MAF Parent Renewal Letter
- Medication Administration Record
- Non-Public School Summary List for Daily Medications - Treatments
- Non-Public School Summary List for PRN Medications - Treatments
- Office of School Health Review for Special Services
- Opioid Overdose Prevention Program Policies and Procedures
- Receipt Of Equipment - Medication Pickup Last Day of School
- Receipt Of Equipment - Medication Received
- Reminder Letter for Additional Supply of Equipment - Medication
- Treatment Administration Record
- Verbal Order Addendum Form
- Verbal Orders Protocol
Nutrition
- Alternative Milk Form
- D75 Dietary Accommodations - Student Tracking Log
- School Nurse Food and Beverage Request
Office of School Health Memos
- Afterschool Approval Letter Memo
- OSH Substitute Nurse Coverage Call in Procedure
- RN Registration Certificate Memo
Office of School Health Policy
- Policy and Procedures Manual is currently being updated
Role of the School Nurse
Resources and Miscellaneous Forms
- 12S Physician Referral Form
- Easy Order Tip Sheet
- Easy Order Request Sheet
- EMS ASHR Reporting Guide
- EMS Reporting Form
- Incident Report Guide and Forms
- Individual Staff Development Request Form
- Naloxone Resources
- SH-10 School Nurse Form
- SH-65 Medical Immunization Requirements
- Student Death Reporting Form
- Student Medical Record Request Protocol
- Talking Points for Nurses
Borough Nursing Director and Nurse Supervisor Directory
School Trip Information
- OSH Trip Order Form
- Parent-Guardian Permission to Designate Another Adult to Administer Medication
- Request for Personal Asthma MDI for School Trip Alert
- Supervised Student Listing for Field Trip
- Trip Nurse Policy
- Trip Plan and Service Record
Supervisor Section
- Contract Agency Concerns Form
- DOE Employee Instructions for Workers' Comp
- DOE Nurse Time Sheet
- DOE Nurses - Request for Payment of Overtime
- DOE Sick Leave Form, OT, PT, RN
- Supervisor Site Visit Form
- Supervisor Site Visit Continuation Form
- WH-380-E Employee Own Illness
- WH-380-F Family
Tuition and IMPREST
- Tuition Reimbursement Information
- Tuition Reimbursement Course Form
- IMPREST Form Instructions
- IMPREST Form