Section two

Privacy Notice: It is necessary to collect this information to ensure that
we can provide appropriate care for students. If at any stage you wish to THE KING’S SCHOOL
access any health information we hold about your son/ward you may contact the Bursar’s Of ice. We wil disclose this information to certain PO Box 1 PARRAMATTA NSW 2124
staff and on occasions to health service providers and other persons as ABN 24 481 364 152
stated in the School’s Collection Notice if the necessity arises.
Please complete this form in conjunction with your son’s doctor as a physical examination is required

The student wil report initial y to the School Health Centre or, in respect of the Preparatory School, the Preparatory School Sick Bay, where the member of staff on duty wil complete an attendance sheet. ♦ The registered nurse (or the appropriately trained member of the Preparatory School Staff) on duty wil assess and treat as required (or refer the After hours, boarding house supervisors wil attend to the health needs of students and, if necessary, refer the student to the School Health Centre. ♦ If a student is injured whilst playing sport he wil report, if able, to the First Aid station (eg sports field) and First Aid wil be administered on site or he My son’s Year Group in 2014 wil be (please circle): K 1 2 3 4 5 6 7 8 9 10 11 12 wil , if deemed appropriate by the suitably qualified person in attendance, attend the School Health Centre or closest public/private hospital. SERIOUS AILMENTS OR INJURIES
If a student has a serious ailment or injury which requires a doctor or public/private hospital consultation/admission, the fol owing procedures wil be EMERGENCY CONTACT NUMBER
The parent/guardian wil be contacted as soon as practicable as per the information given to the School. ♦ First Aid wil be administered by the School nurse or staff member on hand. In the event we are unable to contact you (the parents or guardians), please nominate a person to contact in an emergency: ♦ The School doctor or another general practitioner may be called in to attend the student. ♦ If the School nurse deems it necessary, the student may be taken straight to a public/private hospital. ♦ In the event of an emergency, or on advice of the attending school doctor, the student wil be taken by ambulance or other suitable vehicle to the nearest available public/private hospital. STUDENT’S GENERAL PRACTITIONER (Family Doctor)

Please inform the School Nurse of any changes to above information
♦ Medicines wil be stored in the Preparatory School Sick Bay, at the first aid stations or, in the case of parent-approved medicines brought from home, in locked cupboards supervised by the Health Care Coordinator. MEDICAL CONSENT
♦ Where appropriate, the student wil self-administer medicines brought from home under the supervision of the Health Care Coordinator. In such cases the parents must previously have given express written permission including dosage and frequency. Such medicine must be sent to the Preparatory School Sick Bay in its original container, with the original label. ♦ The Health Care Coordinator is responsible for keeping a register of the administering of such medicine. provide the information as requested in Section One of this form and also consent to the administration of medications specified in Section One and any other as notified by me/us, in writing as required. Other medicines approved by parents eg “over the counter” medications referred to in Section One wil typical y be administered by the Health Care Coordinator or, if unavailable, a responsible adult staff member. I /We authorise you in the event of injury to or il ness of my/our son/ward to follow the procedure(s) set out in Section Two of this consent. I / We undertake to inform you in writing of any changes to the information in this Form as and when necessary. CONSENT TO ANAESTHETICS, OPERATION AND TREATMENT
In the event that I/we are unable to be contacted in the time available I/we consent to my son’s/ward’s Housemaster (or, in his absence, the Headmaster or his nominee) to give informed consent for my/our son/ward, to undergo an operation in an emergency and to such other procedures including administration of Assistance wil be given by the School Nurse in the administration of prescription medicine if requested in writing by parents/guardians or the School anaesthetics and blood transfusion as may be found necessary during the course of treatment. The School Nurse may only administer or assist with administration of such medicine IF it is presented in its original container and the student’s
name and the required dose are clearly displayed.
♦ The School Nurse, if required, wil arrange prescriptions for boarders and, when necessary, day boys only at the School’s nominated pharmacy. Restricted Medication (eg Ritalin): ♦ Restricted (ie. Schedule 4 to 8) medications required by Boarders must be held in the Health Centre. They must be provided in their original container and be accompanied by a letter from the prescribing doctor containing all appropriate information. Witness - Signed:
Al prescribed and restricted medicines held by the School are stored in locked cupboards or locked refrigerators in the School Health Centre or
Witness – Name:
♦ Instructions concerning changes to the original dose must be provided to the School in writing from the specialist physician. Medical information about a student which is collected by the School, including by the School's medical staff, may be disclosed to relevant staff
at the School, and to parents and guardians of the student, as required in the circumstances.


Please supply details if applicable:
Does your son/ward suffer from Asthma? .  Yes  No Hepatitis B carrier, bed wetting, psychological problems, special needs / disability Has your son/ward been to hospital due to asthma in the past 2 years? .  Yes  No In the past two years has your son/ward had an episode of wheezing? .  Yes  No Current treatments of which the School should be aware (in addition to the above)
Has your son/ward been treated with oral cortisone in the past 12 months? .  Yes  No If you answered “Yes” to any of the above please provide additional relevant information, eg dates, dosage etc.
________________________________________________________________________________________________________________________ “OVER THE COUNTER” MEDICATIONS
________________________________________________________________________________________________________________________ The following “over the counter” medications are held in the School Health Centre and administered to boys for the relief of minor
________________________________________________________________________________________________________________________ allergies, minor pain, coughs, colds and fever etc: Antistine Privine Eye Drops, Telfast, Claratyne, Polaramine, Imodium, Panadol, ________________________________________________________________________________________________________________________ Panadeine, Disprin, Nurofen, Sudafed, Duro Tuss Elixir, Senega. List “over the counter” medications, other than above, that your son/ward may need and for what conditions:
Does your son/ward have an asthma action plan? (if yes please enclose plan) .  Yes  No
Name of Medication
Normal maintenance medication taken when well
Please list “over the counter” medications that are NOT TO BE GIVEN to your son/ward:
Name of medication: _________________________________________________________________________ Name of Medication
Dose of medication: _________________________________________________________________________ Device Used: What signs/symptoms does your son/ward display when their asthma is get ing worse?
________________________________________________________________________________________________________________________ PRESCRIPTION MEDICATIONS
________________________________________________________________________________________________________________________ List prescription medications, their dose and frequency, that your son/ward is currently taking.
________________________________________________________________________________________________________________________ Name of Medication
Medication to be taken when signs/symptoms develop at School
Name of medication: _________________________________________________________________________ Dose of medication: _________________________________________________________________________ Device Used: Medications to be taken immediately before vigorous exercise
PHYSICAL EXAMINATION (To be completed by a Doctor)
Name of medication: _________________________________________________________________________ Dose of medication: _________________________________________________________________________ Device Used: ALLERGIES SECTION
Please provide details of any diagnosed allergies: Any other conditions: (impediment in speech, spine, feet, hernia, etc):
Summary of treatment for each allergy. (If necessary please attach additional information).
• You must provide a NSW Health Department Immunisation Certificate (or ________________________________________________________________________________________________________________________ equivalent in other States, etc). Please attach the School’s Copy.
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________
Please provide details of any operations or injuries your son/ward has experienced, eg date, treating doctor or hospital etc. ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ END OF SECTION ONE


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