Nurses Corner
stsclinic@stsashburn.com
Direct Phone Number: (703) 687 - 4393
Please email the clinic and your child's homeroom teacher if there is an absence.
Middle School students can email msattendance@stsashburn.com
Parents must pick up their sick or injured child in a timely manner when contacted. If the parent cannot be reached, emergency contacts will be called to pick up the child.
Students with fevers and/or contagious or infectious diseases will be sent home promptly and will be excluded from school while in that condition, according to the Virginia Department of Health Regulations. Once the student is confirmed to be free of communicable illness by a health care provider or is fever free/symptom free for 24 hours without taking anti-fever medications, the student may return to school.
Health Forms
School Entrance Health Form
Students who are new to St. Theresa Catholic School will need to complete the Commonwealth of Virginia School Entrance Health Form (below) for each child and turn in to the school office. Remember to copy the original health assessment for your records before submitting the original to the school.
Students who are new to St. Theresa Catholic School will need to complete the Commonwealth of Virginia School Entrance Health Form (below) for each child and turn in to the school office. Remember to copy the original health assessment for your records before submitting the original to the school.
| School Health Form |
Tuberculosis Screening Requirements
All new students attending St. Theresa Catholic School are required to provide documentation that a tuberculosis screening has been performed no sooner than six months prior entering school. The documentation is included in the Commonwealth of Virginia Health School Entrance Form; it must be signed by a licensed health care provider and indicate that the student is free of communicable tuberculosis.
IF that part of your child's Comm of VA Health Form was not completed at a physician's office or is outdated, you will need to have the Tuberculosis Screening Form, below, completed at a physician's office or through the Loudoun County Health Department. Then, please submit to the School Office before the first day of school.
All new students attending St. Theresa Catholic School are required to provide documentation that a tuberculosis screening has been performed no sooner than six months prior entering school. The documentation is included in the Commonwealth of Virginia Health School Entrance Form; it must be signed by a licensed health care provider and indicate that the student is free of communicable tuberculosis.
IF that part of your child's Comm of VA Health Form was not completed at a physician's office or is outdated, you will need to have the Tuberculosis Screening Form, below, completed at a physician's office or through the Loudoun County Health Department. Then, please submit to the School Office before the first day of school.
| Tuberculosis screen |
Medication Authorization Form
For all medications prescribed by a physician, or over the counter medications, except inhalers or Epi-Pens, please print and complete the following form below:
For all medications prescribed by a physician, or over the counter medications, except inhalers or Epi-Pens, please print and complete the following form below:
| Medication Authorization |
Asthma Medication Authorization Forms
For students with asthma, please download and complete the following forms below and return them to the Clinic:
For students with asthma, please download and complete the following forms below and return them to the Clinic:
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Allergy Treatment Plans and Authorization Forms
For students with allergies that use only Benadryl, please download and complete the following form below:
For students with allergies that use only Benadryl, please download and complete the following form below:
| Antihistamine Administration form |
Antihistamine Administration
For students with allergies that use an Epi-Pen or Auvi-Q, please download and complete the following forms below and return them to the clinic.
For students with allergies that use an Epi-Pen or Auvi-Q, please download and complete the following forms below and return them to the clinic.
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Diabetes Emergency Reference Forms
For students with diabetes, please download and complete the following forms below and return them to the Clinic:
For students with diabetes, please download and complete the following forms below and return them to the Clinic:
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Siezure Action Plan
| Seizure action plan |
Confidential Health History Update
| Confidential health history update |
