Forms & Screenings
Allergy History Questionnaire
Asthma Action Plan
Diabetes Medical Management Plan
Emergency Allergy Action Plan
Head Injury Recovery Plan and Accommodations
Massachusetts Certificate of Immunization
Massachusetts Physical Exam Form
Medication Permission Form
Release/Exchange of Information Form
Seizure Action Plan
Seizure Questionnaire
The following state-mandated screenings are conducted each year by the school nurses:
VISION: Grades 1 through 5, grade 7 and grade 10
HEARING: Grades 1 through 3, grade 7 and grade 10
POSTURAL (SCOLIOSIS): Grades 5 through 9
GROWTH (BMI): Grades 1, 4, 7 and 10
SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT): Grades 7 and 9
DPH and DESE have selected SBIRT utilizing the CRAFFT +N screening questionnaire as the approved approach to conduct verbal substance use screening in schools. SBIRT focuses on screening for prevention, risk assessment, brief counseling, and, when needed, referral for further treatment. It helps promote healthy behaviors and change unhealthy behaviors related to substance abuse.