White Township Consolidated School

565 CR 519

Belvidere, New Jersey 07823

http://www.warrennet.org/whiteschool

Linda M. Heilman Telephone 908-475-4773

Chief School Administrator Fax 908-475-3627

TO: Parents/Guardians

FROM: L. Serniuk, R.N., School Nurse

T. Meyers, Transportation Coordinator

DATE: February 29, 2008

RE: Medical Conditions

At the beginning of each school year we ask parents/guardians to complete a form giving permission for the school to share student medical information with the school faculty and staff. If you recall, we need specific permission as a result of the Federal Privacy Guidelines, which no longer allow school nurses to routinely share any child’s medical information.

While the medical information for students whose parents have given written permission is shared on a need-to-know basis with school staff, we do not currently share that information with bus drivers. After meeting with our drivers and conferring with the administration, we believe that it is extremely important that these individuals are made aware of medical conditions that the students on their buses may have.

To that end, we are asking that you complete this form giving explicit permission to share information on a need-to-know basis with bus drivers, and return it to school. (The form will also be on the school website.) In the future, bus drivers will be included on the general permission form sent to parents/guardians at the beginning of school.

If you have any questions or concerns, please call Mrs. Serniuk at 475-3612.

Child’s Name______________________________ Grade______________

Medical information to be shared:

I give permission to share important medical information/educational materials with my child’s bus driver. I understand that this information will be held in confidence, and will be kept with bus route information on the bus.

_________________________________________ ______________

Parent Signature Date