Health Information and Forms


Below you will find the four forms required by The School District of Philadelphia. Information about theses forms can be found in the articles below.

You will also find an immunization calendar. If you have any questions or concerns please contact the school at 215-400-7480.

  • S865 – to be completed by parent to inform nurse of any medical condition/medication use.
  • MED-1– to be completed by students Doctor for medication use during school – including over the counter medication.
  • MED-1 (Asthma)– to be completed by students Doctor for Asthma rescue inhalers.
  • MEH-1-Report of physical examination, to be completed by students Doctor.
  • MEH-155– Dental Examination Form

19-20 School Immunization Requirements

Physical Examinations (MEH-1) are required when entering Kindergarten or 1st Grades, 6th Grade, and 11th Grade.

Dental Examinations (MEH-155) are required when entering Kindergarten or 1st Grades, 3rd Grade, and 7th Grade.

Does your child have a health condition we need to know about?
As the school nurse at Alexander Adaire Elementary School, I would like to know about your child’s health condition.  Please complete the form (S865) and return it to the nurse as soon as possible.

If your child requires medication in school, please contact the nurse or send your child to the health room for the proper form (MED-1) or (MED-1 (Asthma) to be completed by your child’s doctor.  For everyone’s safety, student’s ARE NOT permitted to bring any medications into school without written permission from the parent, doctor, and the approval of the school nurse.  This includes asthma inhalers and over the counter medications.

Thank you for your assistance, and please feel free to call me at 215-400-7480.