Health Services

Dear Crivitz School District Families,

Welcome to the School Nurse/Health Services information page!

We, Cindy Kubicek, RN, BSN, NCSN and Salina Polomis, CNA/Health Room Assistant, are proud to be apart of this great team of professionals dedicated to helping your child(ren) learn, grow, and achieve their potential. Our role in the health services office is to make sure that your child's health needs are met, so they can focus their attention and energy on learning.

Contact us at any time at either 715-854-2721 x347 or ckubicek@crivitz.k12.wi.us. Your communication, feedback, participation and support are always greatly appreciated! We thank you for all you do!

WELLNESS

Healthy Students are Better Learners

"Student health encompasses a wide range of complex topics including physical health, safety, mental health, and social-emotional health. Evidence shows that student health is closely linked to academic achievement, including academic performance, classroom behavior, and cognitive skills and attitudes."

Center for Disease Control and Prevention 2014

District Wellness Policy/Triennial Assessment

HEALTH FORMS

Emergency Action Plan-Asthma

Reminder:

  • Utilize this form if your child has a history of asthma, reactive airway disease or needs a "rescue" inhaler.

  • This form requires the signature of your child's health care provider.

  • Please have this form completed and handed into the school nurse prior to the start of school. If you would like to sit down and review this plan, please call 715-854-2721 x347 or e-mail directly to ckubicek@crivitz.k12.wi.us.

Click here: Asthma-Emergency Action Plan

Emergency Action Plan-Allergic Reaction

Reminder:

  • Utilize this form if your child has a history of severe allergic reactions.

  • This form requires the signature of your child's health care provider.

  • Please have this form completed and handed into the school nurse prior to the start of school. If you would like to sit down and review this plan, please call 715-854-2721 x347 or e-mail directly to ckubicek@crivitz.k12.wi.us.

Click here: Allergic Reaction-Emergency Action Plan

Emergency Action Plan-Diabetes

Reminder:

  • Utilize this form if your child has a history diabetes. Please note, if your health care provider has a different Diabetes Management form, they may be filed with the school nurse in place of this district approved form.

  • This form requires the signature of your child's health care provider.

  • Please have this form completed and handed into the school nurse prior to the start of school. If you would like to sit down and review this plan, please call 715-854-2721 x347 or e-mail directly to ckubicek@crivitz.k12.wi.us.

Click here: Diabetes-Emergency Action Plan

Emergency Action Plan-Seizures

Reminder:

  • Utilize this form if your child has a history of seizures.

  • This form requires the signature of your child's health care provider.

  • Please have this form completed and handed into the school nurse prior to the start of school. If you would like to sit down and review this plan, please call 715-854-2721 x347 or e-mail directly to ckubicek@crivitz.k12.wi.us.

Click here: School Seizure Action Plan

Prescribed Medications

Reminders:

  • Parents/guardians should determine, with their child's health care providers, if medication scheduling can be adjusted to avoid administering medications during school hours.

  • If it is necessary to give medications during school hours, have your health care provider complete AND sign the prescribed medication form (on left side).

  • This form must be submitted each year and again, if any changes to the prescription are made.

  • It must be handed into the school nurse BEFORE medication(s) can be given at school.

  • Parents/guardians must bring the medication to school. Medication may not be sent to school with students. An exception to this would be select emergency medications, including inhalers/epi-pens.

  • The medication must be in an original pharmacy-labeled package. Ask your pharmacy for a "school" labeled bottle to be kept at school.

Click here: Prescribed Medication Form

Over-the-Counter or Short-Term Prescription Medication

Reminders:

  • Parents/guardians are to fill out the Over-the-Counter or Short-term Medication form for any over-the counter medications or short-term (2 weeks or less) prescription medications they wish to have given during school hours.

  • This form must be filed with the school nurse BEFORE medications can be given at school.

  • All non-prescription medications must be in the original manufacturer's package.

  • All short-term prescription drugs should be in an original pharmacy-labled package.

  • NOTE: Select over-the-counter medications can easily be authorized for use at school by contacting the school secretary for form completion. These OTC products include Acetaminophen (Tylenol), Ibuprofen, Antacid Chewables (Tums), Throat Lozenges and certain topical medications (antibiotic ointment, steroid free anti-itch lotion, Aquaphor-for dry skin and Insect Sting-insect sting swabs).

Click here: OTC/Short-term Prescription Medication Form

Student Immunization Record/Waiver

Reminder:

  • State law requires students meet certain age/grade immunization requirements.

  • Utilize this form to update your child's immunization record with the school.

  • If for health reasons, religious reasons or for personal conviction reasons you wish NOT to have your child immunized; fill in Step 4 of this form, to officially waive these requirements. This must be on file with the school to meet legal obligations.

  • For the current school year immunization requirements, click the following link.

Immunization Requirements

Click here: Student Immunization Record/Waiver

Kindergarten Vision Exam Form

The State of Wisconsin encourages parents of Kindergartners to arrange for their child’s eyes to be examined by an optometrist or evaluated by a physician by December 31 of the child’s first year in school.

Click here: Kindergarten Eye Exam

“Nursing encompasses an art, a humanistic orientation, a feeling for the value of the individual, and an intuitive sense of ethics, and of the appropriateness of action taken.”Myrtle Aydelotte