Holy Cross High School, NY, Medical Office

Medical Office Requirements and Forms

	Acrobat Format	Word Format
Medical Examination Form
Personal History Form
Prescription Medication Form
Self Medication Form

Sophomores, Juniors and Seniors must present a Student Participation and Parental Approval Form to the Athletic Director before participating in a sport. This Form only needs to be presented once each year.

Click here for information on Working Papers
Click here for answers to Frequently Asked Questions

Parents/Guardians of incoming Freshmen and Transfer Students:
The following two Medical Forms must be completed and mailed to the Medical Office before your son enters Holy Cross High School.

Medical Examination Form - must be signed, dated and stamped by a doctor, or clinic. This form should be completed after June 1 and mailed to the Medical Office before August 1. This form will also cover freshman interested in participating in competitive sports during the year. ** All incoming students must have the Hepatitis B series. The No Shots, No School Policy is a rigid policy and allows no exceptions.

NOTE: New Students entering Holy Cross High School from outside New York City must present evidence of a Negative Mantoux PPD Test for T.B. This must be obtained from your physician or clinic. Please remember to return to your physician to have your Mantoux test read. Results must be listed.
Personal History Form - must be completed by the Parent/Guardian and returned to the Medical Office immediately.

Please understand that these forms are mandated by the New York City Health Department. New York City law requires that a student be excluded from school if he fails to submit the above requirements.

Please send your forms to Holy Cross High School, 26-20 Francis Lewis Boulevard, Flushing, NY 11358, Attention: Medical Office. We recommend that you keep a copy of your son's records. In the event that your form is misplaced you will not have to return to your doctor to obtain a copy.

Parents/Guardians of All Students:
The Bureau of School Health of the New York City Department of Health requires that all students who need prescription or over-the-counter medication during school hours must present the following two Forms to the Holy Cross High School Medical Office.

The Prescription Medication Form must be completed in addition to the Self Medication Form for any student who needs to take any medication (including over-the-counter medicines) during school hours.
The Self Medication Form must be completed in addition to the Prescription Medication Form for any student who needs to take any medication (including over-the-counter medicines) during school hours.

If you have any questions, please call Mrs. Nora Brandon, (718) 886-7250, Extension 515, or email nbrandon@holycrosshs.org.

Thank you for your cooperation.

Sincerely, Nora Brandon R.N., School Nurse

Requirements for Working Papers

All information must be submitted to the Holy Cross Medical Office between the hours of 7:30am - 8:00am.

Working papers are issued at the Holy Cross Medical Office from September to June only. Otherwise, students must go to their local district high school for working papers..

Application for Employment Certificate
Part One of the Certificate is to be completed by the student and signed by a parent or guardian. This form may be obtained in the Holy Cross Medical Office between September and June of any school year.
Evidence of Age
Students born in the U.S. may present a birth certificate, a driver's license, or a U.S. passport. Students who are foreign-born must present an Alien Registration Card.
Social Security Card
Your Social Security Card must be presented; the number alone is not sufficient. If a student does not have a Social Security Card, he must contact the Social Security Office.
Physical
A Physical Examination must have been given within twelve months.

Frequently Asked Questions
What if my insurance only covers one physical exam per year?
We request that you make appointments in the summer months so that the student is covered without interruption. If your insurance coverage does not allow for a new physical exam until a year from the last one, please have your physician fill the form out based on his last exam. The date of that exam should be on the form. You will than have to return for your son's yearly physical, and have a new form filled out.

Is there anything I need to know about filling out the medical form?
Please be sure to check that both you and the physician have answered all questions to avoid having to return to have the form completed. The doctor must circle Yes or No for participation in sports and gym.

My doctor uses his own forms. Can I send that instead of the Holy Cross Form?
If the physician wishes to use his own form, he may but he must also complete the consent section at the bottom of our form with his signature and stamp. Both forms must be attached with the students name and returned to the MEDICAL ROOM at Holy Cross High School by August 1.

Can my son get over-the-counter medication from the nurse while in school?
If you wish for your son to get over-the-counter medication while in school both medical and parental permission are required. Sign the consent on the form and be sure your physician initials it.

What is the procedure if my son needs to bring medication to school?
If a student brings a one day supply of a prescription or over-the-counter medication, it must be in a regular medication bottle. Please provide a parent note and have the student see the school nurse. Some medications (Insulin, Epi-pen or long term medications) may require additional forms to be completed by a physician. Please contact the school nurse if your son is prescribed medication for more than one day.

What is the procedure for extended absence?
If a student is absent due to illness for more than three days, or is scheduled for test or surgery, please notify the school nurse directly at 718-886-7250 ext. 515, or email nbrandon@holycrosshs.org, or in a note.

How can my son get his working papers?
Working papers are issued thru the medical office from September to June. Only students presently attending Holy Cross High School will be issued working papers.