Parents should complete the student handbook forms online at the start of the school year. The forms include a section about food allergies.

Further info is available here.

Medicaid Parent Authorization Form - English

Medicaid Parent Authorization Form - Spanish

Medicaid Parent Authorization Form - French

Medicaid Parent Authorization Form - Portuguese

Medicaid Parent Authorization Form - Vietnamese

Physical Exam

Medication Administration - Parent letter

Medication Administration- Physician letter

Health Services Pamphlet

Emergency Form - English

Emergency Form - Spanish

Emergency Form - French

Emergency Form - Portuguese

Emergency Form - Vietnamese

Each student must have a physical examination within one year prior to trying out for any sport. It is recommended that a student-athlete have his/her physical examination administered by their family physician.

Physical Form Immunizations

Entry into
Kindergarten

• DTaP/DTP - 5 doses
• Polio - 4 doses
• MMR - 2 doses
• Varicella - 2 doses
  OR physician certified history of chicken pox
• Hepatitis - 3 doses - birth or first dose- 1 month after first dose- 6 months after first dose
• Lead Screening
• Physical exam done by primary care provider
• Vision Screening - including stereopsis*All copies should be sent to School Nurse.
  To print out forms to bring to the physicians office
• IMMUNIZATION FORM
• PHYSICAL FORM

*Stereo E test plate with an array of dots that appear randomly oriented, but when viewed through the stereo glasses a large letter "E" will appear if the child has normal binocular vision.

DTaP/DTP ≥ or 3 Td + 1 Tdap

• Polio - 3 or more doses
• MMR - 2 doses
• Varicella - 2 doses
  OR physician certified history of chicken pox
• Hepatitis - 3 doses - birth or first dose- 1 month after first dose- 6 months after first dose
• Physical exam - Fourth grade - done by primary care provider

All copies should be sent to School Nurse.To print out forms to bring to the physicians office click here:

• IMMUNIZATION FORM
• PHYSICAL FORM

Grade 7: 1 dose of MenACWY ( brand name Menveo or Menactra) for all students
Grade 11 entry: 1 booster dose of MenACWY received on or after 16 years of age.
(1 or more doses of MenACWY are acceptable as long as 1 dose was received on or after 16 years of age.)

DTaP/DTP - 4 doses or 3 doses Td plus 1 dose Tdap

• Polio - 3 or more doses
• MMR - 2 doses
• Varicella - Grade 7: 2 doses
• Hepatitis - 3 doses - birth
  • - 1 month

• - 6 months

• TD/TDaP - 1 dose upon entry to 7th gr.
  • Or if > 5 yrs since last dose DTP/DTaP

Physical exam - Seventh grade

• Tenth grade
• SPORTS physical each year of participation before tryouts
• All copies should be sent to School Nurse.
  To print out forms to bring to the physicians office, click here:
• IMMUNIZATION FORM
• PHYSICAL FORM

Required physicals: Preschool/kindergarten, Grades 4, 7, 9
Vision: Grades K-5, 7, 9 & referrals as needed
Hearing: Grades K-3, 4, 7, 9 & referrals as needed
Postural screening in Grades 5 - 9
Annual height and weight (Body Mass Index) in Grades 1, 4, 7, & 9
Interval health histories

DAILY SCREENING

• Communicable disease (doctor's note required)
• Five day absences (doctor's note/school nurse clearance required for re-entry)
• Follow up referrals
• Student illness referrals

Freshman Health Screening Day takes place in the spring, in the BHS locker rooms, during gym period. Screenings will include Massachusetts Mandated Vision screening, Hearing screening, Heights & Weights, and Postural Screening.

(SBIRT) Screening, Brief Intervention, and Referral to Treatment in Grades 7, 9
Public Schools will participate in SBIRT, which is a public health approach to delivering early intervention to anyone who uses alcohol and/or drugs in unhealthy ways. Because school nurses and counselors are uniquely positioned to discuss substance use among young people, it is recommended that schools allow for opportunities for appropriately trained staff to reinforce prevention, screen for substance use, provide counseling and make referrals as necessary to all adolescents, including students in middle school grades. Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) focuses on prevention, early detection, risk assessment, brief counseling and referral intervention that can be utilized in the school setting. School nurses and counselors will use a validated screening tool to detect risk for substance use-related problems and to address them at an early stage in adolescents. if you wish ot opt out of this screening please notify your school nurse in writing.

Legislative Mandate: MGL c71 s57 "…Upon entering kindergarten or within 30 days of the start of the school year, the parent or guardian of each child shall present to school health personnel certification that the child within the previous 12 months has passed a vision screening conducted by personnel approved by the department of public health and trained in vision screening techniques to be developed by the department of public health in consultation with the department of education… "…For children who fail to pass the vision screening and for children diagnosed with neurodevelopmental delay, proof of a comprehensive eye examination performed by a licensed optometrist or ophthalmologist chosen by the child's parent or guardian indicating any pertinent diagnosis, treatment, prognosis, recommendation and evidence of follow-up treatment, if necessary, shall be provided."

We would like to inform you of the policies that have been put in place to ensure the health and safety of children needing medication during the school day.

Our school district requires that the following forms must be on file in your child's health record before we begin to give any medicine at school:

1. Signed consent by the parent or guardian to give the medicine. Please complete the enclosed consent form and give it to your school nurse.
2. Signed medication order. The written medication order form should be taken to your child's licensed prescriber (your child's physician, nurse practitioner, etc.) for completion and returned to the school nurse. This order must be renewed as needed and at the beginning of each academic year.

Medicines should be delivered to the school in a pharmacy or manufacturer-labeled container by you or a responsible adult whom you designate. Please ask your pharmacy to provide separate bottles for school and home. No more than a thirty-day supply of the medicine should be delivered to the school. To ensure positive identification of your child, it is required that you provide the school nurse with a picture of your child which will be attached to the medication log.

When your child needs medication during the school day, please act quickly to follow these policies so we may begin to give the medication as soon as possible. Thank you for your cooperation in this matter.

Medication is not dispensed in school on half days. If you have any questions, please contact the School Nurse. Thank you.

If you have a child that will be taking medication in school, please print, and complete the following forms and return to the school nurse:

Medication parent permission | Medication physician letter

Medication change protocol | Medication policy | Medication count

• Important Information About Skin Infections!
• Guidelines for Sick Children
• Guidelines for Parents about Influenza
• Hand Washing
• Breakfast
• Snacks
• Let's Eat!
• Your Child Needs Daily Activity -- Make It Fun & Safe!
• Give Your Child Healthy Food Choices At Home

Asthma/Allergies

• Asthma & Allergy
• Food Allergy Network

Diabetes

• American Diabetes Association

Sickle Cell Disease

• Tips for Supporting Students with Sickle Cell Disease

Miscellaneous

• Caritas Good Samaritan
• WebMD
• Massachusetts Department of Public Health- School Health Services
• Centers for Disease Control
• Massachusetts Department of Education
• Kids Health
• Brockton Hospital
• Brockton Neighborhood Health Center
• Brockton Board of Health
• City of Brockton
• MA Interscholastic Athletic Association (MIAA)

1. The nurse provides services with respect for human dignity and uniqueness of the client unrestricted by consideration of social or economic status, personal attributes, or the nature of health problems.
2.The nurse safeguards the client's right to privacy by judiciously protecting information of a confidential nature.
3.The nurse acts to safeguard the client and the public when healthcare and safety are affected by the incompetent, unethical or illegal practice of any person.
4.The nurse assumes responsibility and accountability for individual nursing judgments and actions.
5.The nurse maintains competence in nursing.
6.The nurse exercises informed judgment and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities and delegating nursing activities to others.
7.The nurse participates in activities that contribute to the on-going development of the profession's body of knowledge.
8.The nurse participates in the profession's efforts to implement and improve standards of nursing.
9.The nurse participates in the profession's efforts to establish and maintain conditions of employment conductive to high quality nursing care.
10.The nurse participates in the profession's efforts to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing.
11.The nurse collaborates with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public.

Comprehensive School Health Services Program Grant

The Department of Public Health has promoted a Comprehensive School Health Services (CSHS) Program that utilizes the best practices in delivering care to the students of the Commonwealth.  Currently there are 351 cities and towns. Brockton is the sixth largest city in the state of Massachusetts. Currently Brockton Public Schools system serves 16,000 students. The goal of this grant is to provide services that are community based and are culturally and linguistically appropriate meaning that services address racial inequities and health disparities.

Case management will be instituted to ensure that students with complex health needs can access services and attend school safely.  Data driven Quality improvement projects will identify gaps in the various health disparities.  Connecting families with needed services is the priority goal of the health services department.

As part of our continued efforts to keep COVID-19 out of our schools, we ask that BPS families follow the following protocols.

First, we ask anyone who is exhibiting any of the symptoms listed below to remain home and take a test.

• Fever (100.0° Fahrenheit or higher), chills, or shaking chills
• Difficulty breathing or shortness of breath
• New loss of taste or smell
• Muscle aches or body aches
• Cough (not due to other known cause, such as chronic cough)
• Sore throat, when in combination with other symptoms
• Nausea, vomiting, when in combination with other symptoms
• Headache, when in combination with other symptoms
• Fatigue, when in combination with other symptoms
• Nasal congestion or runny nose (not due to other known causes, such as allergies), when in combination with other symptoms

If you test positive for COVID-19, your self-isolation period is a minimum of 5 days.  Day zero is the date of test, if asymptomatic, OR date of onset of symptoms. 

You may return to school anytime on or after Day 6 if you have been without a fever for 24 hours (without fever-reducing medication) AND have experienced improvement in other symptoms (i.e. no longer have a severe cough or body aches, or difficulty breathing).   

Following the 5-day isolation period, you must mask for 5 additional days when around others. You do not need to test negative for COVID-19 prior to returning. 

Families should continue to report their absences to the school and notify their school nurse if their child tested positive for COVID. As indicated at the start of the school year, the district is following the attendance policies detailed in the student handbooks.

Access helpful resources to promote heart health, courtesy of the American Heart Association, by clicking here.