Mercy School Medical Forms

Form Information:

New Students: Please submit a Certificate of Medical Examination form (linked below) including all immunizations.

Preschool: Please submit a Certificate of Medical Examination form (linked below) including all immunizations. This form needs to reflect that your child has had a medical exam within the last year.

Kindergarten: Please submit a copy of your child’s current immunization record. The following immunizations are required by ODH for all children prior to kindergarten entry: 4 doses DTaP, 3 doses IPV, 2 doses MMR, 3 doses Hepatitis B, and 2 doses Varicella.

7th grade: Please submit a copy of your child’s updated immunization record. There are 2 vaccinations required by ODH prior to entry into 7th grade, which include: 1 dose of Tdap and 1 dose of Meningococcal/MCV4. It is highly recommended that you submit these before the end of the current school year to avoid the summer rush for physicals and doctor visits. As a reminder, these are required prior to the beginning of 7th grade.

Students who take prescription or over-the-counter medications: All students who take medication are required to have an updated Authorization to Administer Medication form (linked below) completed by the physician and parent annually. In addition, medication needs to be in its original container and be brought into the office by an adult (students may not bring it in).

Students with asthma: If your child has asthma, a completed Asthma action plan (linked below) is required. 

Students with allergies requiring an Epipen: If your child has a food or bee sting allergy, a completed Emergency Care Plan (linked below) 

All health forms are linked here 

Please send the completed forms to cschneider@mercymontessori.org