Student Health Form

Student Health Form

This Health Form will be kept in the RIS Admission’s Office.

Tamanho máximo do arquivo: 5MB

*The information on this form will be confidential and will only be shared with school personnel on a need-to-know basis

Student and Family Information

Family Name | First/Given Name | Middle Name
Student resides with:

For Emergency Use

If Parents Cannot Be Reached

Permission For Emergency Care

NOTE: Please notify the front office of any changes in contact information

Student Health History

To be completed by parents

Does your child have a history of any health concerns or medical conditions?
Please complete this section and accompany it with a Medical Health Certificate (reporting the student is in good health).

Neurological (e.g., Seizures, Headaches, Syncope)
Heart Problems (e.g., Rhythm & Sounds)
Breathing or Lungs (e.g., Asthma, Tb, Cystic Fibrosis)
Stomach, Digestion
Skin Problems (e.g., Eczema, Rashes, Scars, Psoriasis)
Kidney, Bladder
Allergies (e.g., Food, Medicine, Environmental)
Endocrinology/Hormonal (e.g., Diabetes, Thyroid)
Blood Disorders (e.g., Anemia, G6PD, Hemophilia)
Psychological/Developmental (e.g., Depression, Bipolar, Anxiety)
Nutritional Status (e.g., Over/Under weight, Eating disorder)
Hospitalizations/Surgeries
Attention Deficit Disorder

PERMISSION TO GIVE MEDICATIONS

While at school, all medications, whether prescription or over-the-counter, must be dispensed from the front desk personnel. With the exception of asthma inhalers and Epi-pens, students are not allowed to carry any medicines with them at school.

Please check Yes or No for each medication & sign/date. For a description of medications, please contact frontdesk@riointernationalschool.com

Paracetamol / Tylenol
Dipirona /Novalgina

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