May 18, 2022


Dear St. Agnes Academy-St. Dominic School Families,


As the school year is quickly coming to an end, we want to say thank you for a wonderful year in the clinic. We have absolutely loved being here and have thoroughly enjoyed our time with your children. Their physical and emotional needs, along with communicating with you, will always be a top priority.


Before we break for summer, we wanted to share the following list of important reminders that will assist in making the back to school season seamless and less stressful for all!


Immunization Records: 

  • Please review the list of immunizations your child should have for their grade. This is extremely important for Kindergarten and 7th grade students. Please don't wait until the last minute to reach out to your pediatrician.


  • Families who live in Arkansas or Mississippi, your healthcare provider has access to the Tennessee form. Please have them print your immunization record on this form.  


EpiPens, Inhalers, and Any Other Prescribed Medications: 

  • If your child has an EpiPen, please make sure to have your prescribing provider fill out and return the “EpiPen Standing Order” form to the clinic, along with an unexpired EpiPen clearly labeled with your student’s name and grade. 
  • If your child uses an inhaler, please have your prescribing provider fill out the “Asthma Action Plan” form and return it to the clinic along with an inhaler that is labeled with your student’s name and grade. 
  • Any prescription medications that are to be administered during school hours must be turned in to the clinic along with a “Physician Authorization” form. The medication must be in the original bottle with the medication name and dose, prescriber information, patient’s name, and administration information. Examples of these medications would include medications for ADHD, depression, anxiety, migraines, etc… 
  • For older students who keep their EpiPens and/or inhalers with them and are competent in administering their own EpiPens and/or inhalers, please have the “Physician Authorization” form filled out and return it to the clinic.

 

Thank you for your continued love and support in keeping our students at St. Agnes Academy-St. Dominic School happy and healthy. As always, please feel free to call or stop by the clinic with any questions. 



Warmly,


Nina Gardner, RN

[email protected]



Sandra Miller, FNP

[email protected]




Asthma Action Plan

EpiPen

Over the Counter Medication

Physician Authorization Medication(s)

Sample TN Immunization Form