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Universal Health Form for New Jersey
This can be used for any child who needs a “physical form” to attend daycare/preschool/camps.

New Jersey High School Sports Form
This can be used for all students entering high school and playing sports.

Non-Parent Consent Form
This form can be used to allow an adult who is not a legal guardian to bring your child to our office for health care.

Asthma Treatment Action Form
This form can be used for school administration of asthma medication and inhaler use.

Print the PACNJ Asthma Treatment Plan to discuss with us and drop off or mail a signed copy to the school nurse. The form is a fillable form that you can fill out on your computer or print and fill out.

Your Asthma Treatment Plan tells you:

  • What medicine to take
  • How much medicine to take
  • When to take your medicine
  • What to do in an emergency
  • What things trigger your asthma –
  • like dust, mold, pets, odors
  • For Parents of Children with Asthma

New Jersey Law requires students with asthma to have an Asthma Treatment Plan on file with the School Nurse.

For students to carry their inhaler in school, your Health Care Provider must check off approval at the bottom of the PACNJ Asthma Treatment Plan.

Carry Water Bottle Note
This form can be used to authorize the carrying of a water bottle during the school day.