Student Life

Health Services


Overview of Health Evaluation Programs at Bishop Eustace Prep

View Health Requirements for the 2016-2017 School Year

Medication Policy

Health Screenings

Information on Cleared to Play Status


Please refer to requirements for the current school year above to determine which forms you are required to submit each year.  All Health forms are now downloadable and will no longer be mailed home.

Pre-Participation Evaluation (PPE): History + Physical Exam + Clearance Form + PPE Addendum (download below)
Beginning school year 2014-2015 all New Jersey schools were required by the NJ Department of Education (DOE) to use this (PPE) form set.  This PPE is the only form acceptable.  ALL signatures must be legible or identified in print.

PPE Addendum 
Provides required information missing from the NJ DOE form.  Three page PPE + Addendum are required for complete download.

Medication Consent / Denial of Consent Form
Required for EVERY student, by the Department of Education and the Camden County Health Department, ANNUALLY at the beginning of each school year.   

All Medication “Consents” must be signed by the Parent/Guardian and co-signed by the examining Medical Provider ;  “Denials” may be signed by the parent only. All Signatures MUST be legible and/or identified in print.                   

Note:  Students who still have not submitted this form after the first cycle (A to F day) in September will be excluded from classes until the form is in.

Self Medication Form AND Emergency Action Plans (choose 1 or more below)  
Required ANNUALLY for each student who needs to carry medications at school.  Please refer to the Medication Policy above or in the Student Handbook. 


  1. Requires 3 signatures: Student, Parent/Guardian AND Medical Provider (signatures MUST be legible &/or identified in print).
  2. Please review Medication Policy above regarding back-up doses required to be kept in the Nurse’s Office and medication expiration procedures.
  3. A current, non-expired, dose should be submitted during orientation if not left in the Nurse’s Office from last school year.

Emergency Action Plans

Please choose the appropriate Emergency Action Plan(s) for your condition(s)/Self-Medication and submit it/them WITH the Self -Medication form (above):
     Potential Anaphylactic Reactions – To Foods, Medications, Bee Stings, Unknown Allergens etc. - Epi-Pen / Auvi-Q / Benadryl etc.
     Reactive Airway – Asthma – Inhalers
     Diabetes – Students are required to submit their current “Diabetes Management Plan re: Testing, Insulin / Glucagon etc.
     Information on Hyper/Hypo…Glycemia is downloadable
     Migraines – Rx Medications

Control Drug Protocol Form
Required for all students taking FDA identified Controlled Drug Substances at school either on a regular or as needed basis.

New Student Consent/Release Form
Required for all incoming Freshmen and all Transfer students of any grade level. Must be signed 2X for 2 legal consents:

  1. Emergency release of information, and
  2. Required Screenings NOT documented on submitted Physical Exam forms

Additional Documentation - May be Required

Unresolved health or injury issue from the prior school year     and/or
Any significant change in health status REQUIRES a Physician's note regarding the current status of each issue.  These notes should be submitted during orientation.

Requests for Physical Education Exemption & Acute Injury Updates during the school year:

            A single day excuse REQUIRES a note, fax, or e-mail request from a parent/guardian.

            A multiple days excuse(>1) REQUIRES a doctor’s note which must include: 
                  1. Student Name, Date, & History of Injury  
                  2. Condition/Injury Diagnosis,
                  3. Specific Restrictions or Accommodations,   
                  4. Date of Clearance or Next Evaluation, and
                  5. A Legible Signature.               
The exemption / update will remain in effect only until the specified date of clearance or a new note is received at the subsequent evaluation.

Note: ALL Physicians’ Notes are to be presented directly to the School Nurse.


Immunization Records 

A complete and up-to-date record from your Primary Health Care Provider of All Immunizations received to date is required for all Incoming Freshmen and Transfer students to be submitted with their Entrance Physical (same form as Pre-participation Evaluation: History/Physical Exam/Clearance-see above).

Immunization Updates

ConfIrmation of immunizations received since the school health record was last updated should be submitted during orientation and with subsequent physical examinations.  These changes will be noted on the student's formal health record.

For information on Cleared to Play Status click here.  
Call the School Nurse at (856) 662-2160 ext. 298 with any questions

Bishop Eustace Preparatory School

5552 Route 70, Pennsauken, NJ 08109-4798

Phone: 856.662.2160

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