Clinic Information

Apologies for the inconvenience. We appreciate your patience while we update the information and necessary forms.

All students must meet the medical requirements before attending school.

Required for all ECC, Kindergarten, and new K-8 students.

All ECC and first year K-8 students will provide a physical and immunization record to the school. Physicals must be completed within 365 days of the start of school.

The physical and immunization records must have the students name and date of birth on them and be signed or stamped by the practitioner.
Immunization records may be signed by a nurse from the office.

Physical and immunization records must be an original, photocopy or scanned version. No photos will be accepted.
Link to the form:

Required for students with an allergy.

Any student with an allergy listed by the physician must have an allergy action plan or a physical form with “none” checked under response required to an allergic reaction.

Medications listed on the allergy action plan must be provided to the school along with the appropriate form completed by the medical provider.
Medication and forms must be brought together to the nurse prior to the start of school.
If the parent chooses not to provide the medications, they must submit a signed diocesan release form relieving the school of any liability.

New forms are required each school year.

If a student requires an EpiPen this form is required.

If a student requires an antihistamine such as Benadryl for an allergic reaction this form is required.


Required for students with seizures, diabetes, or asthma.

Any student with seizures, diabetes, or asthma must have an action plan filled out and signed by the provider on the appropriate diocesan form.

Seizure Plan

Diabetic Medical Management Plan

Students requiring an inhaler will require this form.
Please note, students who need an inhaler in grades 6-8 may carry them if the medical provider checks the box on this form. The student must have a second inhaler available in the clinic.

Over-the-counter and prescription medication information.

Over the counter and prescription medications must be provided to the clinic by the parent with the form.
Over the counter medications may be given no more than 3 consecutive days before a Licensed Health Care Provider (LHCP) signs the form.
All prescription medications must have the form filled out by a LHCP. Follow all instructions on page 2 of the form.

Reminder, students are not allowed to carry medications while on school property.

The school will only dispense medications provided by the parent with the appropriate form.

Vaccination Information

The Virginia Department of Health requires that all students receive a Tdap (Tetanus, Diphtheria, and Pertussis) booster and the meningococcal conjugate vaccines prior to entering the 7th grade.
Effective July 1, 2021, a complete series of 2 doses of HPV vaccine is required for students entering the 7th grade.
The first dose shall be administered before the child enters the 7th grade.
After reviewing educational materials approved by the Board of Health, the parent or guardian, at the parent’s or guardian’s sole discretion, may elect for the child not to receive the HPV vaccine.

Health Screening

3rd and 7th grade students will receive a vision and hearing screening in the fall.
Parents of any student noted to have an abnormality in this basic screening will be notified.

It is recommended that parents check students in grades 5-8 for scoliosis, curvature of the spine, once a year.
Please click the link for instructions.

Please contact the school nurse for any questions, concerns, or assistance by calling the school office at (703) 988-4170

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