Student Health Record - St George's College

STUDENT HEALTH RECORD

STUDENT INFORMATION

Student's Full Name *

Student's Date of Birth *

GENERAL PRACTITIONER

GP Name *

Address *
Post Code *

Please be advised the College requires a person available to act as an emergency contact.

Do you give permission for our Health Centre to contact your GP/Specialist if necessary? *

Yes

Does your child regularly take medication prescribed by their GP or Homeopathic Practitioner? *

Yes

Please provide full details and contact our Health Centre if medication is required to be taken during school hours

Students on any medication must give this to the Health Centre to dispense in its original container/packaging. Please note Homeopathic medication is not administered by the Health Centre and should not be carried into the College by students.

Has your child had any serious illness, operation or accident? *

Yes

Please provide details

Does your child have a disability? *

Yes

Please provide details

MEDICAL HISTORY

Please note: The information provided on this form will remain confidential and filed securely by the Health Centre in your child’s school health record. Relevant information will be shared with teaching staff so they are aware of any health needs. Please indicate clearly on the form if there is information you do not wish to be shared in this way.

Check as appropriate. If YES, please give full details.

Has your child ever had:

Asthma *

Yes

Do they currently carry an inhaler?

Yes

Eczema or other skin condition *

Yes

Allergies (please specify) *

Yes

Epilepsy, other seizures or blackouts *

Yes

Diabetes *

Yes

Difficulty with hearing/vision/speech *

Yes

Any disability or congenital abnormality? *

Yes

Emotional or psychological issues *

Yes

Any other health problem or behavioural problems that might affect him/her at school? *

Yes

If YES to any of the above, please provide details

Does your child have any special dietary requirements? *

Yes

Please provide details

Please specify

Does your child carry an Epipen? *

Yes

It is the responsibility of the parent/guardian to ensure an up to date Epipen is carried by the student at all times and supply a spare up to date Epipen to be kept at the Medical Centre for emergencies.

Is your child currently receiving any medical treatment? *

Yes

Please provide details

ADMINISTRATION OF MEDICINES IN SCHOOL

The Health Centre keeps a stock of over the counter remedies in school for the treatment of common ailments. Please indicate your consent for the Health Centre to administer these medicines to your child at school in age appropriate doses as necessary.

I consent to the Health Centre giving my child:

Ibuprofen Gel- 5% w/w – only for children 14 years and over *

Yes

Buscopan tablets - for stomach ache/cramping *

Yes

Paracetamol suspension 250mg/5mls *

Yes

Paracetamol Tablets 500 mg/Soluble Paracetamol Tablets 500mg *

Yes

Ibuprofen tablets 200mg - 400mg *

Yes

Ibuprofen suspension 100mgs/5mls *

Yes

Rennie antacid tablets *

Yes

Antihistamine tablets or syrup (Piriton or Cetirizine) *

Yes

Antihistamine cream for bites/stings *

Yes

Strepsils for sore throats *

Yes

E45 cream *

Yes

Zovirax *

Yes

Super Freeze Spray *

Yes

Burn Gel *

Yes

e-Signature of parent/guardian *
Date *

IMMUNISATIONS

Second Year girls at St George’s College are offered the new HPV vaccination to protect against cervical cancer. This is in the form of two injections yearly.

The current childhood immunisation schedule as recommended by the Department of Health is:

AGE	VACCINE
8 weeks old	DTaP, IPV, Hib, HepB, Pneumococcal, Conjugate Vaccine (PCV), MenB, Rotavirus
12 weeks old	DTaP, IPV, Hib, HepB, Rotavirus
16 weeks old	DTaP, IPV, Hib, HepB, PCV, MenB
1 year old	Hib, MenC, PCV, MMR, MenB booster
2-8 years old	Live Attenuated Influenze Vaccine (LAIV)
3 years 4 months old	MMR
12-13 years (girls only)	Human papilloma virus (HPV) 2 doses given 6-12 months apart
14 years	Diphtheria, tetanus and polio, Men ACWY

Please note: It is important to keep the Health Centre updated of any changes to your son/daughter’s medical information as it occurs. This can be via letter or email.

Email: collegehealthcentre@stgeorgesweybridge.com

Telephone: 01932 839325

St George’s Weybridge is a data controller and is registered with the Information Commissioner’s Office as required under Data Protection law. The School will use the information provided for education administration purposes and will only process your personal data in accordance with the School’s registration and current data protection legislation. Further details on the Schools Data Protection Policy can be found on our website at https://www.stgeorgesweybridge.com/privacy or a copy can be provided at your request.

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