Nurse’s Office and Printable Forms

Nurse’s Office Information: All students in grades K through 12 on any medication must have all medications brought to the health room by their parent or guardian in accordance with school district policies and procedures. This includes all medications – whether the medication is prescribed by a doctor or an over the counter medication. For everyone’s protection, at no time should medication be brought into the school by students.

If medication is prescribed by a doctor the health room must have a written order signed by the doctor in order to give the medication. If the medication is an over the counter medication the health room must have a written permission slip from a parent or guardian in order to give the medication. A copy of the over the counter medication permission slip is available in the health office or on-line by clicking the link below. Please note all medications must be in their original labeled container with the students name clearly identifiable on the label. In the case of prescribed, controlled substance medications, parents or guardian must count the medication and sign a form in the presence of the school nurse. If your student is on an antibiotic or other short term medication, many pharmacies will give you a second bottle properly labeled to bring to school upon request to save back and forth trips to the health room. Please contact Mrs. Nierzwicki at 570-546-3125 (elementary extension – 1160; high school extension – 3280) with any questions. Thank you for your cooperation.



  • Stacie Nierzwicki
  • Nurse
  • 570-546-3125 ext 1160
  • Tina Mccloy
  • Nurse Assistant
  • 570-546-3125 ext 3280


Click here for a copy of the district Over the Counter Medication Form and Prescription Medication Form



Nurse to Administer Medication Form

Authorization for (Student) Self Carry and Administer Medications

Physical Exam Form

Dental Exam Form

PIAA Physical Form

UPMC Consent to Treat Form



#210 Use of Medications

#210.1 Possession and Use of Asthma Inhalers/Epinephrine Auto-Injectors