School Nurse

Mrs. Erin Giarrusso

Mrs. Erin Giarrusso
School Nurse
973-543-7107 ext 221

Health & Emergency Forms

Asthma Action
Form to be updated annually for all students requiring asthma medication.
Epinephrine and Food Allergies
Form to be completed annually by parent/guardian.
6th Grade Immunization Letter and Immunization
Mandatory for all 6th graders. Vaccine Table must be completed by physician by the start of grade 6.

- 2018-19 6th grade ONLY Immunization Letter and 6th grade Vaccine Table (FORM M 9)

Permission Form for Administration of Medication
Form to be completed annually
- Permission for School Nurse Administration of PRESCRIPTION MEDICATION (FORM H 4)

- Permission for School Nurse Administration of OVER THE COUNTER (OTC) MEDICATION (FORM H 6)

Screening Exemption Form
Form to be completed annually
-Health Screening Exemption Form (FORM H 3)-ANNUAL RENEWAL REQUIRED

Sports Related Eye Injury Fact Sheet
(FORM A 6) (read only)
Opiod Use and Misuse Information and
SIGN OFF SHEET (requires signature)

All medicine, including Prescription and Over-the-Counter (OTC), must be accompanied by written permission. This means that for a student to receive any medicine, including Tylenol or Advil, the nurse needs written permission. New Jersey State rules and regulations have prompted all these changes:


  • The Mendham Township Board of Education forbids any student from carrying any medication
    (OTC or prescription) without the knowledge and consent of the administration and school nurse.
    Medication shall include all medicines prescribed by a physician, including emergency medications,
    i.e., inhalers and Epi-pens, and all non-prescription OTC medication.
  • For the students' convenience, we will stock regular-strength and Jr. strength Tylenol (acetaminophen), Advil (ibuprofen), Pepto Bismol, and Tums, but we will still need written permission to administer them. This can be done on the yearly emergency information form. Any other OTC medication shall be brought to school in the original, sealed container, and labeled with the student's name. All medication is to be taken home by the parent when it is no longer needed, or at the end of the school year.
  • Prescription medication shall be brought to school by the parent, unless other arrangements have been made with the nurse. It must be in the original prescription container, and labeled with the name of the student, medication, dosage, and name of the physician.

Health Screenings

  • Vision, Hearing, Height, Weight and Blood Pressure are monitored yearly.
  • Parents are notified if a significant problem is noted.
  • Scoliosis screenings are done bi-annually for 5th and 7th graders in the spring. Letters are sent home approximately 1 month prior to screening, you may choose to exclude your student from this screening. Please use the link below to exempt your child from these screenings:
    Screening Exemption Form (must be completed annually) Screening Exemption Form

Links & Resources

We Can!
A national program that offers information for families and communities to help children maintain
a healthy weight through activity and good food choices.
American Academy of Pediatrics
Provides useful and up-to-date information for parents/guardians concerning physical, mental, and
social health issues from infancy through young adulthood. An important resource for
parents/guardians who may have questions about specific health, social, or developmental concerns.
Centers for Disease Control
Gives health and safety information for the purpose of achieving improvement in people's
wellbeing. This site provides current information on almost any health and safety topic
as well as publications and products.
National Institutes of Health
A medical research agency whose purpose is to improve health and save lives. There are 27
institutes and centers which make up the National Institutes of Health (NIH) and provide
helpful information and fact sheets concerning medical conditions and achieving optimal health.
Healthy People 2010
Provides a comprehensive set of guidelines for disease prevention and health promotion.
Covers a wide range of health topics.
NJ Dept of Health and Senior Services
Makes available the state codes used by the Hillsborough Board of Education to develop the
district policies concerning health services.
USDA's new 2010 dietary and exercise guidelines for healthy living. Has fun tools for
tracking dietary intake and exercise progress. MyPlate has replaced the MyPyramid program.
American Diabetes Association
The American Diabetes Association (ADA) is the leading nonprofit organization for diabetes in
the US. Provides information for parents/guardians, students, and healthcare professionals.
A great resource for all your diabetic questions.
American Heart Association
A resource to learn about cardiovascular diseases, stroke, and prevention. Has a specific
section on children's health.
American Cancer Society
Provides information on cancer for patients, family members, survivors, and health care
professionals. Site includes cancer facts, treatment options, support services, and a bookstore
as well as other useful features.
The Food Allergy & Anaphylaxis Network
Makes available information concerning allergies with special attention to food allergies. Also
provides information about managing food allergies in childcare and school settings. Has
seperate teen and kid specific web sites.
Allergy and Asthma Network
This web site is designed to help people live with allergies and asthma. There are specific
sections on coping with allergies and asthma in the home, childcare, and school settings.
Provides useful information in regards to pets, play time, and shopping.


Protocol for Absences
Providing a healthy and safe environment for your children is the primary goal of the School Nurse.
The following guidelines must be used when determining if your child should be kept home from school:
  • Common Cold - Your child may return to school when the severity of the symptoms subsides
    and the temperature has been normal for 24 hours without medication.
  • Ear Infections - Your child may return when pain free and the temperature is normal.
  • Fever - Your child may return when their temperature has been normal for 24 hours without medication.
  • Lice - If your child has lice. Parent(s)/Guardian(s) must treat the child’s hair
    (contact your doctor for further instruction), and remove the lice eggs from the hair.
  • Pink eye - Your child may return after being on medication for 24 hours.
  • Pneumonia/Bronchitis - Consult your physician.
  • Strep Throat - Strep is not contagious after 24 hours on appropriate medication. I suggest that you
    keep your child home for 48 hours as a matter of good health practice. Always remember to replace
    your child's toothbrush after a strep infection.
  • Vomiting/Diarrhea/Flu - Your child may return after there has been no vomiting or diarrhea and is
    fever free for 24 hours.
Protocol for Exemption from P.E. & Activities at School
Physical Education is a regular part of our school curriculum. If a child has an injury or illness that
requires that they be excused from activity in physical education, a physician’s order MUST be sent
to the nurse and will be given to the PE teacher
. It is expected that any child who has restricted activity in physical education will have restricted activity at recess. We need to be certain that any student who is recovering from an injury or illness is safe at school.

Student-Athlete Information


  • Please check the middle school calendar for deadlines for sports physicals/paperwork, seasonal sports sign ups and tryout dates.
  • Student's eligibility for tryouts is determined by a current sport physical on record in the health office before tryout day. (A current physical means that a student has had a physical within 365 days prior to the tryout date and a completed state mandated form is on record for the student in the health office.)
  • The 90 Day Health History update form is a NJ state requirement and is necessary if the date of the physical on file is over 90 days from the first day of tryouts.
  • Students who do not have this paperwork in the health office by the sports calendar deadlines WILL NOT BE ELIGIBLE FOR TRYOUTS!! NO EXCEPTIONS WILL BE MADE!!
  • Please call the health office, 973-543-7107 ext. 221, if you are unsure of your child's eligibility.

Forms Required for Athletic Participation

The following must be completed, submitted to the nurse, and approved by our school doctor prior to try-outs. There will NEVER EVER be exceptions.

- Athletic Participation Physical Examination Forms (FORM A 1) (REQUIRED for athletic participation / grades 6-8 ONLY)

- 90 Day Health Update Form for Athletics - Parent to complete (FORM A 2) (required if physical is dated more than 90 days prior to first sports practice)

- Concussion Head Injury Fact Sheet (FORM M 4) (requires signature)

- Player Contract (FORM A 3) (requires signature)

- Athletic Emergency Card (FORM A 4) (requires signature)

- Sudden Cardiac Death in Young Athletes (FORM A 5) (read only)

-Opiod Use and Misuse Information and
SIGN OFF SHEET (signature required)

Sports Related Eye Injury Fact Sheet
(FORM A 6) (read only)