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What we need from you to ensure a healthy and safe day for
your student:
A Completely and accurately filled out Emergency Care Card.
Note: We MAY NOT release your student to anyone who is not on the ECC.
Please cooperate when you are asked to come in to sign for your child. This is a saety measure
to protect you and your student.
Please contact me at 703-481-4072 if you have any questions or if your child has a health
condition that impacts his/her school day and would need a health plan.
If your Student needs medications, we are required to stricly follow FCPS regulation 2102.
(For more info see the opening packet and the FCPS website www.fcps.edu)
This includes:
Appropriate Forms completely and correctly filled out and on file in the clinic. (center)
Forms may be gotten at the clinic or downloaded at www.fcps.edu/forms
Medication in a appropriately labeled orginal container An adult must carry the medication in the clinic.
Authorization for Medication - www.fcps.edu/DIT/forms/se63.pdf
Authorization for Use of Inhaler - www.fcps.edu/DIT/forms/se65.pdf
Emergency Care Information for
Students - www.fcps.edu/DIT/forms/se3.pdf
Emergency Care Prevention of
Anaphylaxis Release and
Indemnification Agreement for Epinephrine - www.fcps.edu/DIT/forms/se64.pdf
School Entrance Health Form - www.fcps.edu/DIT/forms/mch213.pdf
Student Health Information - www.fcps.edu/DIT/forms/se71.pdf
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