University of Pittsburgh

School Nurse

Health does not start in the doctor's office,

but instead takes shape

where we live, learn, work and play.

--James Marks, MD,MPH, Robert Woods Johnson Foundation

Susan Sholtis, Room 106 -- 412-624-8023

Health Forms

Annual Health Information for 2012-2013 School Year (pdf) --  This form is for students in all grades and is completed by the parent(s).

Physical Exam Report (pdf) -- This form is for students new to Falk School, including Kindergarten, students entering grade 6 and students who plan to participate in extra curricular sports.  This form is completed by your health care provider.

Dental Exam Report (pdf) -- This form is for students new to Falk School, including Kindergarten, and all students entering Grade 7.  This form is completed by your dentist.

Medication Administration Form (pdf) -- This form is to accompany every medication brought to school and is completed by the parent.  See Medication Policy for more information.

Download the Sports Questionnaire/Permission to Participate Form--2-15-12 (pdf) 

Healthful Sites

Children's Hospital of Pittsburgh's website provides information for parents, kids, and teens in an easy-to-use format.www.chp.edu

From the American Academy ofFamily Physicians, this website includes informationon common ailments, health tools such as BMI (body mass index) calculator and "Search by Symptom,"over-the-counter medications, health living, and more.In the Parents & Kids section, special "kid-friendly"information is available.  For example, informationfor parents on causes and treatment of vomiting includes, for kids, "What's puke?" www.familydoctor.org

This online service has existedfor 10 years and provides a wide variety of medicalinformation, including a Children's Health sectionfound under "Healthy Living." www.mayoclinic.com

This is a service of theNational Library of Medicine, and includes healthtopics, drug information, dictionaries, directories,and libraries. www.nlm.nih.gov/medlineplus