DEPARTMENT OF HEALTH & WELLNESS

PLEASE HAVE READY THE CHILD'S IMMUNIZATION RECORDS
TO BE UPLOADED IN THE END OF THIS FORM. YOU CAN ALSO TAKE A PICTURE IF NECESSARY. THANK YOU!

REQUIRED HEALTH INFORMATION 

On the following pages is the official health information required for every student entering Kindergarten in Framingham Public Schools. To begin school, your child will need documentation of the following:

You can submit the immunization record and supporting documentation by uploading it at the end of this form.

Thank you!

KINDERGARTEN:

• A copy of your child’s most recent physical examination (MUST BE within the last 12 months)
• Preschool vision screening from health care provider (MUST BE within the last 12 months)
• Lead Screening
• TB Test Results or Risk Assessment Form

CHILDCARE/PRESCHOOL:

Attendees Requirements listed in the table below apply to all attendees ≥for 2 years. These requirements also apply to children in preschool classes called K0 or K1.

• Hib - 1-4 doses
  The number of doses is determined by the vaccine product and the age the series begins
• DTaP/DTP – 4 doses
• POLIO – 3 doses
• HEPATITIS B – 3 doses
  laboratory evidence of immunity is acceptable
• MMR - 1 dose
  the first dose must be given on or after the 1st birthday; laboratory evidence of immunity is acceptable.
• VARICELLA – 1 dose
  the first dose must be given on or after the 1st birthday. A reliable history of chickenpox* or laboratory evidence of immunity is acceptable.
• LEAD TEST

GRADES KINDERGARTEN - 6:

• DTaP/DTP – 5 doses
  Four doses are acceptable if the fourth dose is given on or after the 4th birthday. DT is only acceptable with a letter stating a medical contraindication to DTaP
• POLIO – 4 doses
  the fourth dose must be given on or after the 4th birthday and ≥6 months after the previous dose, or a fifth dose is required. Three doses are acceptable if the third dose is given on or after the 4th birthday and ≥6 months after the previous dose
• MMR - 2 doses 
  the first dose must be given on or after the 1st birthday, and the second dose must be given ≥28 days after the first dose; laboratory evidence of immunity is acceptable
• HEPATITIS B – 3 doses 
  laboratory evidence of immunity is acceptable
• VARICELLA – 2 doses 
  the first dose must be given on or after the 1st birthday and the second dose must be given ≥28 days after the first dose; a reliable history of chickenpox* or laboratory evidence of immunity acceptable or physician documentation of the history of chickenpox.
   

In an emergency, if parents/guardians cannot be reached, the school is authorized to contact:

In the event of an emergency situation where parents cannot be contacted, I authorize the school to obtain medical/emergency treatment for my child.

The school physician for Framingham Public Schools, with the approval of the School Committee, and in compliance with the Massachusetts Department of Public Health Regulations (105 CMR 210.00) has authorized the district’s school nurses to administer the following over the counter medications during the school day:

• IBUPROFEN (Advil, Motrin)—for headaches, body aches, or menstrual cramps
• ACETAMINOPHEN (Tylenol)—for headaches, body aches, or menstrual cramps
• BENADRYL—for general allergy symptoms
• TUMS/MAALOX—for upset stomach or indigestion
• VISINE ALLERGY RELIEF - for eye allergy symptoms

To assure the safe administration of OTC medications to students during the school day, the school nurse will:

• Assess the student’s condition, current medication profile, history of allergies and evaluate the need for medication.
• Review the signed parent permission form, which is valid for one school year.
• Call the parent/guardian to confirm, when necessary, the time of the last dose given.
• Administer the correct dosage according to the physician’s written protocols.
• Document the medication administration in the electronic health record.
• Contact parents/guardians who have requested notification following OTC medication administration during the school day.

DEVELOPMENTAL HISTORY

ALLERGIES

MEDICATIONS:

If you have any questions or concerns, please contact the Framingham Public schools - Department of Health and Wellness Phone: 508-626-9197

Thank you!