nurse hat Welcome to the Nurse's Office
Please feel free to contact us with any questions or concerns regarding your child.


**Attention Spring Athletes**

It's time to submit forms for the 2017 Spring Season!!  

Please adhere to the following Deadlines for Medical Forms:


All Athletic forms for Spring must be submitted to health office no later than February 17, 2017



Please remember that NO student is allowed to participate in official practice until forms are submitted and reviewed by our school physician for clearance.  Therefore, if forms are submitted after the February 17th deadline, there may be a delay in clearance. 



All athletes require the following forms: 

Click on forms to download and print 

**NEW FORMS as of MAY 2014; no other forms but these will be accepted 

Health History Update Questionnaire

*All Spring Athletes must submit a New Health History Update Questionnaire that is completed and signed by parent/guardian within 90 days of the start of season. 

This is required EACH sport season, regardless if you played in fall or winter. 


PreParticipation Evaluation Forms (Physical Form)
This physical is valid for one full year. 

A new copy is not necessary if you already submitted to health office and it is still valid

  • PreParticipation Physical Evaluation Forms are to be completed, signed, stamped and dated by the examining physician.       
  • The physician MUST sign off that he/she completed the cardiac assessment module.  
  • This NEW 4 page packet includes:                 
  1. History Form
  2. The Athlete with Special Needs
  3. Physical Form
  4. Clearance Form           

 Physical Exams are valid for ONE YEAR ONLY.  You may not participate with expired physical. 
Please be sure the physician signs, stamps and includes date of physical, and checks off clearance status.
Your physician must sign the portion of the physical that states he/she has completed the cardiac module.  The physical can not be accepted if your physician has not signed this or if he has not completed this module.  **Please check this prior to your appointment.


FAQ regarding Physicals 


Checklist for Athletic Forms


Health History Update Questionnaire

·      Required for ALL athletes and submitted prior to EACH SPORT SEASON

     SO if you play a fall, winter and spring sport, you will require a new health history update prior to each season

·      Completed by parent/guardian

·      Must be signed and dated within 90 days prior to official start of practice

o   For winter sports, must be dated after September 1, 2016


PreParticipation Physical Evaluation Forms

·      Required for ALL athletes; Physicals valid for ONE year only

·      4 page packet (all pages must be completed) includes:

History Form: (completed by parent)

§ All questions answered; signed by parent

Athlete with Special Needs Form: (completed by Parent)

§ If not applicable, write N/A and parent signs off

Physical Exam Form: (completed by MD)

§ Height, weight, Bp and pulse

§ Date of exam

§ VISION; if the examining doctor does not perform eye screening and you see an eye doc, you must supply proof of exam from your eye doctor.  The doctor completing the physical can not just write “optho” in that section as this is not complete. If you pediatrician completes and eye screening and documents this, then you do not require an extra note from your eye doctor

§ Clearance checked

§ Signed and dated by MD

Clearance Form : (completed by MD)

§ Clearance checked off

§ Any allergies

§ Any other pertinent medical information

§ MD must sign that he/she has completed the Cardiac Assessment Professional Development Module or physical can not be accepted.  BE SURE TO CHECK THIS PRIOR TO APPOINTMENT.  NO PHYSICAL CAN BE ACCEPTED BY AN MD WHO HAS NOT COMPLETED THIS.





 Only our school physician has the authority to review and medically clear athletes to participate in sports. What this means is that if you do not have your COMPLETED paperwork submitted by Feb 17,2017  you run the real risk of not being able to participate in tryouts on the first day of the season.  Please see the athletic web page for first day of practice schedule.  

The school doctor will be reviewing each and every individual student's paperwork who intends on going out for a Spring sport. You will not be able to hand your paperwork in to the nurse's office and practice that afternoon. It could be a week or more before you are cleared, depending on when the school doctor is scheduled to come to PV to review these documents.


This will be the procedure for the 2016-17 school year and subsequent years. 

Please Submit your paperwork in ASAP so you are able to participate on first day of tryouts.


**Please follow the links at the left to download forms.  PLEASE DO NOT EMAIL OR FAX FORMS!  These will not be accepted.


Diane Fallon, RN, CSN                                   
Certified School Nurse                                
(201) 358-7060 ext. 24021                            
Fax: (201) 358-8894                                  
***Follow me on Twitter: @PVHS_Nurse                              
Sandy Hroncich, RN
Part Time School Nurse
(201) 358-7060 Ext 24022
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