School Nurse
School Nurse
Our School Nurse oversees a responsive hub for student care, parent resources, and information regarding medical dates, forms, procedures, and other health matters. Parents and the school nurse establish a warm relationship by staying in regular contact; the school nurse also reaches out to family physicians and sending school districts to ensure that our students’ medical needs are met.
Commonly-used forms found here can be downloaded, printed, filled out, and faxed to the Y.A.L.E. School Philadelphia school nurse using the contact information below. Our school nurse also prepares helpful newsletters seasonally for the benefit of families.
Please reach out to our school nurse with questions or concerns:
Carol Polowczuk, RN
215-839-0525
Fax: (267)297-8520
nurse@yaleschoolpa.com
Medical Forms
All downloads are in PDF format. Download Acrobat Reader.
- Asthma Treatment form
- Consent for Administration of Prescribed Medication
- Consent for Acetaminophen (Tylenol) or Ibuprofen (Motrin)
- Consent for Administration of Epinephrine
- Allergy and Anaphylactic Form
- Food Allergy Questionnaire
- Seizure Questionnaire for Parents
- Seizure Action Plan
- Consent to Share Seizure Information (Paul’s Law)
- Diabetes Plan
- Consent for Medical Treatment
- Concussion Sign-off Sheet
- Physical Examination Form
- PIAA Comprehensive Initial Pre-Participation Physical Evaluation
- Working Papers
- Immunization Requirements
- Immunization Exception
