The Student Emergency and Medical Information Form (S-865) gathers information about a child's health history. This history can be vital in case of emergency or should the need for any type of medical treatment arise while a child is in school. This must be filled out, either electronically or hard copy, every year by parents/guardians to allow the school nurse to medicate their child with Acetaminophen or Ibuprofen as prescribed by the School District’s medical Officer/pediatrician. Nurses cannot administer medication without parental permission.
This form is the digital version of the School District of Philadelphia's S-865 form. If you prefer to complete a paper copy of the form, you can access it
here. Please bring all completed forms to our main office during the first week of school.
