Name: ______________________________ Grade: _____ Date: _____________ Time: ________
The following has presented to the School Nurse with the following symptoms that are consistent with COVID-19:
Fever of ________ Cough____ Shortness of breath or difficulty breathing____Fatigue/Tired____ Muscle/Body Aches____ Headache____ New loss of taste or smell____Sore throat____Congestion or runny nose____ Nausea/vomiting/Diarrhea____ Other: _______________________________________________________________
Returning to School after Illness
Schools must follow CDC, NYSDOH and Washington County Public Health for “Return to School” guidance.
Please read A and B carefully.
A HAS SYMPTOMS OF POSSIBLE COVID-19 ILLNESS, BUT IS DETERMINED NOT TO HAVE COVID-19 BY A HEALTH CARE PROVIDER (MD, NP, Physician Assistant) CAN RETURN TO SCHOOL WHEN
A NOTE FROM YOUR HEALTH CARE PROVIDER STATING YOU ARE CLEARED TO RETURN TO SCHOOL IS REQUIRED AND PROOF OF NEGATIVE PCR TEST (swab) MUST BE GIVEN TO THE SCHOOL NURSE BEFORE RIDING THE SCHOOL BUS OR ENTERING THE BUILDING.*
B IS DIAGNOSED WITH COVID-19 BY A HEALTH CARE PROVIDER BASED ON A TEST OR THEIR SYMPTOMS, THEY SHOULD NOT BE AT SCHOOL AND SHOULD STAY HOME UNTIL:
A NOTE FROM YOUR HEALTH CARE PROVIDER STATING YOU ARE CLEARED TO RETURN TO SCHOOL ALONG WITH A RELEASE FROM QUARANTINE FROM PUBLIC HEALTH IS REQUIRED AND MUST BE GIVEN TO THE SCHOOL NURSE BEFORE RIDING THE SCHOOL BUS OR ENTERING THE BUILDING.*
* Physician notes can be dropped off to the School Nurse, emailed or faxed. Parent/Guardian must reach out to the School Nurse with updated information from the Health Care Provider as necessary.
Contact your health care provider as soon as possible for guidance and if any symptoms become worse, CALL 911.
Your signature below indicates that the above information has been explained to you, you understand it and have received a copy.