School Nurse

Health Room: 215-400-3430  Ext 1240

In an effort to offer the best possible care for your student at Cook – Wissahickon Elementary School, we would like to provide some clarification on the information we collect and what is necessary for in-school medication administration.

First, is the “Student Emergency/ Medical Information” form also referred to as the “865”.    This form is extremely important as it allows the nurse to quickly access the most pertinent contact and emergency care information on your child. This form also includes parental permission to administer Tylenol for headaches, fever and pain and permission for administration of Motrin, which can only be given for menstrual cramps, per Philadelphia School district policy. A NEW form must be filled out each school year.

Next, if you would like a medication administered to your child, whether scheduled daily OR on an ‘as needed’ basis, such as an albuterol inhaler, it is necessary to have your childs’ doctor fill out “REQUEST FOR ADMINISTRATION OF MEDICATION” also called a MED-1 form. THIS DOCUMENT MUST BE FILLED OUT AND SIGNED BY YOUR CHILDS DOCTOR.

Without this form, we CAN NOT accept medications into the health room and we CAN NOT administer medications.  This form is good for one school year only and expires every June.  Please note that once you have the completed MED-1 form from your doctor, you can send in the MED-1 form with your childs’ prescribed medication into school in the original labeled container.  We CAN NOT accept envelopes, bags or reused bottles.  The medication must be labeled by the pharmacy and in the original container.   These requirements are per Philadelphia School District policy and are in place for the safety of all students.


ALL 6th graders are required to have a Physical Examination, including state mandated immunizations.

The Form is called “Report-of-Physical-Examination-Form” also known as the  MEH – 1.   Please send in the completed form OR whatever paperwork from your childs’ doctor has provided you so that we can update your child health records in our School Information System.


PLEASE NOTE – if your child has been diagnosed with a Life threatening allergic reaction and requires an EPI pen, or another emergency injectable and/or benadryl – THESE MUST BE SUPPLIED BY THE PARENT accompanied by the MED-1 form mentioned above.  The School does not have a “stock” Epi pen, or other emergency injectable.  To be clear, if your child has an anaphylactic reaction in school and we do not have an EPI pen, we will call 911 immediately and contact the parent immediately but we do not have any other tools to help your child until an emergency team arrives.

Thank you so much for your support and please don’t hesitate to contact the Health Room at 215-400-3430  Ext 1240 with any questions or concerns.