School Nurse's Office
Phone: 301-733-9330 Ext. 3006
Fax: 301-671-2591
Email: nurse@stjames.edu
Please scan and upload forms into Blackbaud between June 15 and July 30, 2021.
For more information about Infirmary and health policies visit:
2020-2021 Student Handbook
Healthy History & Physical
Health History Form
Physical Form
New forms must be completed prior to the beginning of each academic year. It is therefore advisable to schedule your child’s appointment for either June or July of each year.
Forms Needed for COVID Testing
Meritus Medical Patient Registration & Consent Form
Meritus Release of COVID-19 Testing Results
Immunization Certificate
Print out form here for: Maryland Department of Health and Mental Hygiene Immunization Certificate
PPD-TB Form - This test is now required for all international students. Print form here: PPD-TB Form
View vaccine requirements here: Maryland School Vaccine Requirements
Authorization of Medication Form: This form must be completed fully for the school nurse to administer the required medication. A new medication administration form must be completed at the beginning of each school year, for each medication and each time there is a change in dosage or time of administration of a medication.
Print out the Authorization of Medication Form.
Student Care Action Plan Forms:
Allergy Action Plan
Asthma Action Plan
Seizure Action Plan
Diabetes Medical Management Plan
Influenza Permission Form: Please complete this form to have your child receive the influenza vaccine on campus.
Concussion History Form: Must be completed and signed by a parent/legal guardian for each student.
Concussion Clearance Form: Medical clearance for suspected head injury must be completed by a licensed health care provider (LHCP) following a head injury. Provide this form to the health care provider for evaluation of the student's injury. Return the form to the school nurse immediately. If the student is diagnosed with a concussion, the form will be copied by the school nurse and the original form returned to the parent to use at the follow-up visit that clears the student for participation in athletics.
Saint James School Concussion Policy
Download and print form here: Concussion Clearance Form
Health/Medical Insurance Card: A copy of the student's current/valid insurance card (front and back). International students should choose a plan through Independent School Management (ISM). Please read here for more information.
COVID Vaccine Administration: If you would like for your child to be vaccinated against COVID-19 while on campus, then please complete, sign and email the following forms:
SJS COVID Vaccination Permission
Meritus COVID-19 Vaccine Administration Consent
CDC Pre-COVID-Vaccination Screening Form
Medical Exemption from COVID-19 Vaccination: Please complete this form to request an exemption.
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