JESS Medical Permissions Booklet

MEDICAL INFORMATION BOOKLET

Student name:

JESS Sibling name: (if applicable)

Medical Information and Consents Child’s Medical History Infectious Disease

Yes

No

If Yes, Date (mm/yyyy) of most recent occurrence

Yes

No

If Yes, Date (mm/yyyy) of most recent occurrence

Diphtheria Dysentery Infective Hepatitis Measles Mumps Poliomyelitis Rubella Scarlet Fever Tuberculosis Whooping Cough Chicken Pox Non-Infectious Disease Congenital Heart Disease Diabetes Mellitus Epilepsy / Seizures G6PD (Glucose6-Phospate Dehvdrogenase Deficiencv) Rheumatic Fever Thalassemia Eczema Conditions ADHD Dyslexia Asthma Frequent Gastric Problems Frequent Headaches Hearing Problems Vision Problems Glasses Other

Blood Transfusion

Frequency:

Hospitalization

Reason: Date:

Family History

Yes

No

Please Specify

Yes

No

Please Specify

Diabetes Hypertension Mental Disorder Stroke Tuberculosis Allergies Nut Food (e.g. Fish, Shellfish, Kiwi, Egg, Dairy) Insect Environmental Allergy Skin Allergy Other Special Dietary Requirements: Consent for Emergency Treatment In the event that your child requires emergency treatment you will be contacted and asked to collect them from school. If the school is unable to contact you, your child will be taken to a doctor/hospital for diagnosis and treatment. Efforts to contact you will continue.

Please note that giving permission for the school to act in loco parentis is a pre-requisite for participation in certain school trips.

• • • •

I consent to my son/ daughter receiving first aid or urgent medical treatment in school or during any school trip or activity, including during school sports fixtures in and out of school.

I consent to my son/ daughter being taken to a doctor / hospital in the event of a medical emergency.

I acknowledge that this consent is valid for the duration that my child attends JESS. I consent that if reasonable efforts to reach me or my emergency contact fail the school may act in loco parentis.

X Parent’s / Guardian’s Signature …………………………………………………Date _____/_____/20_____

Consent for Medical Examination According to DHA school guidelines, children require a school physical examination at certain key stages in their life: Year 1, Year 4, Year 8, Year 12 and any child new to the school.

This service is currently offered to you by JESS by its own designated doctor. However, if you wish to have your child examined by your own family doctor, you may do so at your convenience. The school will require a copy of the doctor’s report to keep on file in your child’s school health record.

We would like to reassure parents that the safety and wellbeing of the children are of prime importance to us and they will be suitably chaperoned for the examination.

As parents, you will be notified prior to any examination taking place.

•

I consent to my child having school medical examinations whilst at JESS.

X Parent’s / Guardian’s Signature …………………………………………………Date _____/_____/20_____

Record of Immunisation I confirm •

I have provided the school with a copy of my child’s immunisation history

•

I will update the health Office with any changes or new immunisations

Consent for the administration of medication We routinely use over the counter medication. Here are those most commonly used: Oral Medications Panadol Brufen Advil Tablet (over 12 years) Antihistamine Syrup Prospan Syrup Strepsils Isla Moo Lozenges Gaviscon (over 6 years) Medigel

Topical Medications Antihistamine Gel Voltaren Gel Deep Heat Cream Antibiotic/ Antiseptic Ointment Arnica Gel

(Please tick as appropriate) I consent for my child to receive over the counter medication if needed (including but not limited to the above)

Yes

No

Consent for prescription medications (Please tick as appropriate) I give permission for my child to carry his/her own medicine and to self-administer as necessary

Yes

No

Please complete the summary of permissions below with a tick under the correct response:

Consent for

Year

Emergency Treatment

F1-Y13

Administration of Paracetamol

F1-Y13

Administration of Adrenaline Auto-Injector (Epipen)(if required)

F1-Y13

DHA School Medical Examinations

Y1-Y12

Carry own medicine and to self-administer medicine

Y7-Y13

DHA Immunization Programme

Y1-Y13

Yes

No

Dubai Health Authority (DHA) Immunisation Programme • • •

Dubai Health Authority (DHA) has implemented a school-based vaccination programme.

The vaccines are offered to & administered by the DHA to students aged 6 years old and above.

Details of the DHA immunisation requirements are available on the school communicator and parent portal/App

Please note the original immunisation/record book must be available at the time of the vaccination.

• • by law, the schools are required to share your parent mobile with DHA. (Please tick as appropriate)

Yes

No

I give consent for the immunisation of my child If you choose not to have your child immunised at school you must complete the DHA letter attached.

We are aware that the majority of parents use their private medical insurance at a clinic of their choice and this is perfectly acceptable.

X Parent’s / Guardian’s Signature …………………………………………………Date _____/_____/20_____

Letter for refused vaccination in the school premises Student Name & Class: ..................................................................................................................

Date of Birth: ..................................................................................................................

Class/Grade: ..................................................................................................................

School Name: ..................................................................................................................

I am Mr. / Mrs. ..................................................................... (Father/Mother) of Student...........................................

This is to inform you that I have objection for my son/daughter to receive the vaccination in the school premises for the reason of .....................................................................................................................................

I agree & assure to provide the school with a copy of updated vaccination record in regular basis.

Signature: ...............................................................

Date: .......................................................................

Telephone Number: .................................................