Medical Needs At Testing

Medical Needs At Testing

A nurse will not be on-site. A PA Cyber school nurse may follow up with you to formalize your student's health plan for testing.

If you have questions or would like to discuss with the School Nurse Janet Crouse, please email her at janet.crouse@pacyber.org.

Purpose: Providing the information below will help our on-site staff accommodate your child during testing and have a general awareness of your child’s medical needs in case an emergency arises. All Site Managers are trained in First Aid.

Student's Name *

First NameLast Name

Student ID*

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Email*

example@example.com

Parent/Guardian Phone Number*

Please enter a valid phone number.

Which test will your child take?*

PSSAKeystoneBoth PSSA & Keystone

Does your child have Life-Threatening Allergies?*

YesNo

What is the allergen?*

Does the student carry an EpiPen?*

YesNo

Can student self-administer the EpiPen?*

YesNo

Where will the EpiPen be located should the student need assistance?*

Does your child have Diabetes?*

YesNo

Does student have an insulin pump or a continuous glucose monitor?*

YesNo

Does your child require an electronic device to monitor levels?*

YesNo

Can the student manage their diabetes on their own?*

YesNo

Does the student recognize when they are feeling low?*

YesNo

Will the student bring their own snacks?*

YesNo

Does your child have Seizure Disorders?*

YesNo

What type of seizure does the student have? Please describe.*

Does the student have emergency medication?*

YesNo

If it’s a nasal spray, we can give it as first aid, if it’s a rectal suppository, 911 will be called.

Where will the emergency medication be located?*

Does your child have Asthma?*

YesNo

Does the student carry an inhaler?*

YesNo

Can they self-administer the medication?*

YesNo

Where will the inhaler be located should they need assistance?*

Does your child have any other medical needs that we should be aware of during testing?*

YesNo

Please describe*

If a parent will not be staying on-site during testing, a Diabetic Medical Management Plan for the 2022-2023 school year from the student’s physician with both doctor and parent signature must be submitted to the school nurse.

Will a parent be staying on-site during testing?*

YesNo