Charity Ciccone

Certified School Nurse

Kindergarten- 5th grade

Blue Mountain Elementary East

caciccone@bmsd.org

570-366-1065 x 5005

DONT WAIT VACCINATE Info for Parents.pdf

Vaccinations Required for School

Please follow this link for more information on the Pennsylvania school required immunizations.

https://www.health.pa.gov/topics/Documents/School%20Health/SIR8.pdf


Private Physical Form.pdf

Private Physicial Form

Required for all students entering Kindergarten.  

Exams are valid if completed within one year of the school year start. 

Private Dental Exam.pdf

Private Dental Form

Required for all students entering Kindergarten and 3rd grade.  

Exams are valid if completed within one year of the school year start. 

Below are some documents your child may need during the school year.

**Please note a NEW form is needed EVERY school year.  **

medication-permit-pg-1.pdf

Medication Permit

This form is required if your child will need medication during school hours.  We can not administer any over-the-counter or prescription (other than Tylenol and Benadryl) medication with out a signed note from the doctor. 

**A new form is required for each school year**

Self Carry Inhaler - EPIPEN permit .pdf

Self-Carry Permit for Inhaler or Epipen

Needs to be completed by physician and parent for student to carry and self administer  inhaler or epipen during school 

Food-Sting Allergy Pg 1.pdf

Food / Sting Allery Action Plan

If your child has a food or sting allergy, please have your physician complete this form.