Medicamentsen-ligne vous propose les traitements dont vous avez besoin afin de prendre soin de votre santé sexuelle. Avec plus de 6 ans d'expérience et plus de 80.000 clients francophones, nous étions la première clinique fournissant du acheter cialis original en France à vente en ligne et le premier vendeur en ligne de Cialis dans le monde. Pourquoi prendre des risques si vous pouvez être sûr avec Medicamentsen-ligne - Le service auquel vous pouvez faire confiance.

6th health history ods

MESD OUTDOOR SCHOOL
Teacher____________________________
11611 NE Ainsworth Circle
School______________________________
Portland, OR 97220
Phone: 503-257-1600
Site Attending
FAX: 503-257-1592
STUDENT HEALTH HISTORY FORM FOR OUTDOOR SCHOOL AND COMPANION PROGRAMS
In order for your child to attend Outdoor School, all information on this form must be completed. If your child’s condition
changes after you submit this form, please send a note to the Outdoor School nurse
.
Student’s Name _____________________________Birth Date____________________ Age_____________ Sex_______________ Parent’s Name _____________________________ Home Phone_______________________ Cell Phone____________________ Parent’s Name ______________________________ Home Phone_______________________ Cell Phone____________________ Parent’s Work Phone_______________________________ Parent’s Work Phone______________________________________ Emergency Contact #2 ______________________________ Relationship_________________________ Phone_________________ ____ALLERGIES (*please list below) _____ Physical Injuries (recent) Emotional/behavioral or learning concerns *Please provide more specific information about identified health concern including treatment needed while at Outdoor School: ___________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Are there any activity restrictions i.e. strenuous hiking, tug-of-war, etc? ________________________________________________ (vegetarian option could include eggs and dairy) Other pertinent health information:_______________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Legal parents/guardian contacted first whenever possible.
In case of medical or surgical emergency, I hereby give permission to the Outdoor School Coordinator to arrange transport for my child, as named above, to the hospital for evaluation by a physician. _______________________________________________ Child’s Insurance Information___________________________________________________________________________________ Medication Allergy ___________________________________________________________________________________________
DO NOT SEPARATE PAGES
PS11-12/PAGE 1
THIS PAGE
RECORD OF MEDICATIONS ADMINISTERED BY
THE OUTDOOR SCHOOL NURSE

STUDENT NAME:_______________________________________________________

NURSE USE
SCHOOL_____________________DATES ATTENDING_____________________

Use the following key for days medication not given: X = Not at site 0 = Student refuses/parent notified
Self-administration key: SA = Self-Administration NS = No Show
(Please: use one line only per dose administered) (initial each entry)
ODS STOCK Medication Record (PER MD STANDING ORDERS)
(Please: use one line only per dose administered)
DO NOT SEPARATE PAGES
PS11-12/PAGE 4

IF YOUR CHILD IS BRINGING MEDICATION TO OUTDOOR SCHOOL PLEASE READ AND COMPLETE THE
INFORMATION BELOW, IF NOT GO TO THE NEXT PAGE.
MEDICATION RULES
1.
All medication must be maintained and administered by the nurse. Students are not allowed to carry their own medication. Some exceptions are made for emergency asthma inhalers and auto injectors for severe allergic reactions. Any prescription, non-prescription medication must have the following:
Parent must sign the authorization below
 Parent must include the following:
o Name of medication
o Dose (strength and how much) of medication
o Time and Dates medication should be given
o Purpose or reason for medication
 All medication must be in original container (prescription or over-the-counter). No medication will be accepted or
given if they are sent to Outdoor School in unapproved containers (i.e., envelopes, baggies, pill planners etc.)
 Prescription medication must have an accurate label. This includes samples given by physician. If the directions on
the prescription label are different from what the physician is currently prescribing, written instruction is
required from the physician. This also includes directions for over-the-counter medications.
See “Physician
Directions” below.
All inhalers must be appropriately labeled with their prescription.
Sign here if you would like your child to carry and self administer his/her emergency asthma inhaler and/or auto
injector.
 ______________________________________ (parent signature) Name of emergency inhaler and/or auto injector and directions____________________________________________
_________________________________________________________________________________________
_
Your child must be developmentally and behaviorally able to carry and self administer his/her inhaler and/or auto injector.
3.
Vitamins/supplements cannot be given at Outdoor School without a doctor’s prescription and must be in original container. The doctor must give written permission that the student can have over-the-counter medicine with the vitamin/supplement. PARENT/GUARDIAN AUTHORIZATION TO OUTDOOR SCHOOL NURSE TO ADMINISTER MEDICATION I am requesting that my child, ____________________________________, be given or be assisted in taking: Parent /Guardian Signature  __________________________________ Date:__________________ (This authorization applies only to the medication listed above and for the duration of treatment or week. This also authorizes an exchange of information, as necessary, between the nurse, appropriate school personnel, my child’s health provider, and/or my child’s pharmacist.) PHYSICIAN DIRECTION
(required in writing IF prescription label does not match parent direction above)
Special instructions including adverse reactions and action required:_____________________________________________
____________________________________________________________________________________________________________
_____________________ _________________________ ______________
Physician’s Name (print or stamp) Physician’s Signature

______________________________

___________________
____________________
DO NOT SEPARATE PAGES
PS11-12/PAGE 2
STUDENT NAME ___________________________________
AUTHORIZATION FOR ADMINISTRATION
OF OVER-THE-COUNTER MEDICATION
BY THE OUTDOOR SCHOOL NURSE
For the relief of minor health problems that might temporarily affect your child’s comfort while at Outdoor School, the nurse
maintains a small supply of common over-the-counter medications at the site. These medications are administered, as needed, under
the standing orders of the Outdoor School consulting physician(s). Your personal physician does not need to sign for the medications
listed below. Do not send these medications with your student. If needed, our stock supply will be used. THE HEALTH
HISTORY FORM IS CHECKED FOR ALLERGIES BEFORE ANY MEDICATION IS GIVEN.
Medications available for the
Outdoor School Nurse to use for your child are:
Antihistamines (Benadryl, Chlor-Trimeton) Non-aspirin pain/fever relievers (Tylenol
*Epinephrine is a prescription medication that is kept on site for use in the event of a life threatening allergic reaction.
NOTE: Brand names have been listed but their generic equivalent or the same medication of a different brand may be substituted.
We do not stock chewable or liquid pain relievers.
IF YOU WANT YOUR CHILD TO RECEIVE OVER-THE-COUNTER MEDICATION, IF NEEDED, AND AT THE
DISCRETION OF THE OUTDOOR SCHOOL NURSE, SIGN BELOW. IF THIS LIST CONTAINS MEDICATION YOU DO NOT
WANT YOUR CHILD TO RECEIVE, DRAW A LINE THROUGH THAT MEDICATION BEFORE SIGNING.
I authorize the Outdoor School Registered Nurse to administer over-the-counter medication (limited to those on list) under the direction of the consulting physician’s standing orders, as needed, to my child while at Outdoor School. Parent / Guardian Signature  _______________________________________ Date____________________
(A signature must be present above if your child needs any of the above medications while at Outdoor School).

DO NOT SEPARATE PAGES
PS11-12/PAGE 3

Source: http://www.mesd.k12.or.us/os/OutdoorSchool/Russian/Entries/2010/2/5_Formy_dla_roditelej_files/6TH%20Health%20History%20ODS.pdf

Http://www.fda.gov/cder/drug/early_comm/bisphosphonates.htm

Early Communication of an Ongoing Safety Review: BisphosphonatesFDA Home Page | CDER Home Page | CDER Site Info | Contact CDER | What's New @ CDER Early Communication of an Ongoing Safety Review Bisphosphonates: Alendronate (Fosamax, Fosamax Plus D), Etidronate (Didronel), Ibandronate (Boniva), Pamidronate (Aredia), Risedronate (Actonel, Actonel W/Calcium), Ti

Positive airway pressure

Positive Airway Pressure for Obstructive Sleep Apnea Positive airway pressure (PAP) devices provide pressurized air via a nasal or full face mask in order to keep the upper airway open during sleep in patients with obstructive sleep apnea syndrome. PAP Machines These machines provide a fixed pressure at a steady rate with the option of a slight drop in pressure during exhalation (CF

Copyright © 2010-2014 Pharmacy Pills Pdf