Health Forms and Resources

Welcome from the School Nurse

The Health Office provides first-aid and nursing care for students and staff, as well as on-campus health screenings, disease prevention and health promotion education. The Health office does not function as a primary care facility or urgent care. By law, I am not able to make medical diagnoses or prescribe treatments.

When accidents, injuries or illnesses occur during school hours, basic first aid and/or emergency care will be given according to the Maryland Board of Nursing standards and practices. I am able to assess and refer, and will always advise follow up with your child’s primary physician if in doubt, or when further evaluation and treatment are needed.

Please feel free to contact me with any questions.

Kirstie Abernathy MS, RN, CPN

Upper Campus Health Office (12 months - Grade 3) Located in Neubert Cottage

Lower Campus Health Office (Grades 4-12) Located in Upper Elementary Building

Phone: 301-576-2814 

Fax for Health forms: 301-576-2805

Email: kabernathy@barrie.org or nurse@barrie.org

Health Forms

The following forms are required by the State of Maryland. Students will NOT be allowed to start school or participate in any Barrie sponsored activities until these forms are completed and returned.

Instructions
Mail completed forms to Barrie at 13500 Layhill Road, Silver Spring, MD 20906, fax to 301-576-2805, attention School Nurse, or hand-deliver forms directly to the Montessori Office (Kim), or Prep Office (Luticia). 

Deadlines
  • Barrie School
    • All returning and newly enrolled students: Health Forms are due no later than June 1, 2019
    • Students enrolling after June 1: Health Forms are due no later than August 1, 2019.

Required Forms for New and Returning Barrie School Students 2019-20

Completed forms that are turned in for 2019 Barrie Camp and/or summer programs will be used for the next school year. A second set of forms is not required for the 2019-2020 school year if your child attended camp or a summer program in 2019 at Barrie. However, additional forms may be required in order to comply with the health form requirements as specified by student’s grade level. See the Checklist by Grade for more details.

Please contact Kirstie Abernathy at 301-576-2814 if you have questions regarding the forms and what is required.

Emergency and Health Assessment Forms

Part I Health Assessment (OCC) 12 months - Primary 5

Emergency Information Form (OCC) 12 months - Primary 5 

Emergency Information Form (Completed with enrollment agreement) Grade 1-12

Part I Health Assessment Form (Completed by a parent/guardian) Grade 1-12

Medication, Asthma, and Anaphylaxis Forms

Medication Forms

Medication Policy

Prescription Medications: Barrie School Authorization to Administer Medication Form - For students requiring prescription medication. This form can be completed once for the entire school year by a prescribing provider (physician, nurse practitioner, physician’s assistant, dentist, etc.). A new form is required for each medication.

Over-The-Counter Medications: Barrie School Over-The-Counter Medication Authorization Form - To be completed by a prescribing provider and the parents for the administration of over-the-counter medications as needed while at school.

Overnight School Sponsored Activities Form - For students in grades 9-12 who require medications and are able to to self-administer on overnight trips, a Barrie School Self-Administration of Medication Authorization Form may be completed by a prescribing provider and the parents. Please note this is for OFF campus activities only. Students are not permitted to self-medicate at school except for Epi-Pens and emergency inhalers. The form is valid for the entire school year.

Asthma and Anaphylaxis

Asthma: Asthma Action Plan - An Asthma Action Plan is available for students diagnosed with asthma, to be completed by a prescribing provider and parents.

Anaphylaxis: Emergency Care of the Student with a Diagnosis of Anaphylaxis Form - Required for students who have a severe life-threatening allergy and require an Epi-Pen. To be completed by a prescribing provider and the parents. Parents are responsible for supplying the school two (2) Epi-pens of appropriate dosage and two (2) photos of the student.

Health Forms for all Barrie Students in 12m-Kindergarten

Required Forms for Toddlers (12-24 months)

Maryland State Department of Education Office of Child Care Health Inventory

Part I Health Assessment (OCC) 12 months - Primary 5

Part II Health Assessment (OCC) 12 months - Primary 5

Emergency Information Form (OCC) 12 months - Primary 5 

Includes:

  • Part I Health Assessment Form - to be completed by Parent or Guardian
  • Part II Child Health Assessment - to be completed ONLY by Physician/Nurse Practitioner
  • Maryland Department of Health and Mental Hygiene Blood Lead Testing Certificate - to be completed by Parent or Guardian, and Health Care Provider 

Maryland Department of Health and Mental Hygiene Immunization Certificate

Required Forms for Primary Students (3 years-Kindergarten)

Maryland State Department of Education Office of Child Care Health Inventory

Includes:

  • Part I Health Assessment Form - to be completed by Parent or Guardian
  • Part II Child Health Assessment - to be completed ONLY by Physician/Nurse Practitioner
  • Maryland Department of Health and Mental Hygiene Blood Lead Testing Certificate - to be completed by Parent or Guardian, and Health Care Provider

New Students in Grades 1-12

Part II Health Evaluation Form - To be completed by your prescribing provider no more than twelve months prior to the first day of school. 

Maryland Department of Health and Mental Hygiene Immunization Certificate

ALL Students in Grade 7