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Health Services

Welcome and thank you for visiting Avon Public Schools Health Services. Health Services provides a number of forms and publications for Avon families.

Patricia DeRossi

Nurse Coordinator
Pine Grove School

Ellen Farrell

School Nurse
Thompson Brook School

Gina Glynn

School Nurse
Avon Middle School

Susan Lane

School Nurse
Avon High School

Patricia Lorenzen

School Nurse
Roaring Brook School

Stacey Pillsbury

Nurse
Avon High School

Marybeth Twohig

School Nurse
Avon High School

IMPORTANT DOCUMENTS & FORMS

Below you will find a variety of important documents and forms for your convenience.  Forms are designed to be printed and signed by hand before returning to the school. Documents can be viewed online or downloaded. If you need assistance with any of these documents or forms please contact your school nurse.

administration of epinephrine for emergency first aid

Refusal to permit administration of epinephrine for first aid form

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About:
Connecticut law requires the administration of EpiPens to students in emergency situations. This REFUSAL form is a written directive from the parent/guardian for the EpiPen not to be administered to their child. Form is valid for the 2018-2019 school year.


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

allergy management plan

Allergy Asthma Management Plan

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About:
An outline of responsibilities that explains what is needed to determine a student's condition and a student's individualized care plan.


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Concussion Education Plan and Guidelines for Connecticut Schools

Concussion Education Plan and Guidelines for CT schools

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About:
This document provides accurate information, resources and guidance needed to implement school district concussion education plans.


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Early Childhood Health Assessment Record

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About:
State of Connecticut Department of Education Health Assessment Record for children ages birth - 5. (FORM-yellow)


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Health Assessment Record

Health Assessment Record

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About:
State of Connecticut Department of Education Health Assessment Record for Kindergarten to 12 grades as well as sports participation. (FORM-blue) 


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

HIPPA FORM

HIPPA Form

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About:
Avon Public Schools HIPAA-compliant authorization form for the exchange of health and education information. (FORM)


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Husky A and Husky B (English)

Husky A & B (English)

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About:
This document provides information on low cost or free health insurance coverage through Husky Health Connecticut. (ENGLISH)


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Husky A and Husky B (Spanish)

Husky A & B - Spanish

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About:
This document provides information on low cost or free health insurance coverage through Husky Health Connecticut. (SPANISH)


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Immunization Requirements 2018-2019

Immunization Requirements 2018-19

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About:
This document provides immunization requirements for enrolled students in Connecticut schools for 2018-2019 school year.


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Medical Authorization Form

Medical Authorization Form

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About: 
Authorization for the administration of medication by school, child care, and youth camp personnel. (FORM)


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Medical Exemption Certification

Medical Exemption Certification

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About:
State of Connecticut Department of Public Health Medical Exemption Certification Statement. (FORM)


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

NASN guidelines for keeping a sick child home

NASN Guidelines for keeping sick child home

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About:
NASN Guidelines for Keeping a Sick Child at Home.


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

oral health screening (revised july 2018)

Part 3 Oral health screening document

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About:
State law required oral health assessment conducted in either grade six or grade seven, and in either grade nine or grade ten.


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Religious Exemption Statement

Religious Exemption Statement

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About:
State of Connecticut Department of Public Health Religious Exemption Statement. (FORM)


 

Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.

Husky A & B (English)

Please click image to view document.

Concussion Education Plan and Guidelines for CT schools

Please click image to view document.