Connecticut Technical High School System
Norwich Technical High School
590 New London Turnpike
Norwich , Connecticut 06360
(860) 889-8453
Dear Parent/Guardian:
According to the CTHSS Procedural Plan for Managing Life Threatening Food Allergies ( July 1, 2006 ), it is the responsibility of the parent/guardian to inform the school nurse about any serious or life threatening food allergies your child may have. If your child has a food allergy requiring prescription medication or one that causes swelling of the face and/or throat, itching, vomiting or diarrhea PLEASE fill out the questions below and return it to the school nurse as soon as possible . This information will be used in the process of developing an individual Emergency Care Plan for students who take medication, such an Epi Pen, at school or who have special needs such as allergic reactions. According to the CTHSS Procedural Plan this letter will be sent out twice during the school year. Please remember, it is the parent/guardian's responsibility to notify the school nurse anytime there is a change in the health status of your child. You can reach the school nurse with any questions at (860) 889-8453 ext. 2149. Please make sure you supply 2 doses of the Epi Pen and Benadryl if needed.
Known Allergies: Peanut___ Tree Nut___ Milk___ Egg___ Fish___ Shellfish___ Soy____ Wheat___ Other food allergies_______________________________________
Bees___ Other Insects____ Latex_________Other:______________________________
Known Asthmatic: Yes_____ No_______
Describe Reactions both Severe and Subtle:__________________________________ ________________________________________________________________________________________________________________________________________________
Usual Treatment: ________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Epi Pen: Yes____ No____ Benedryl: Yes___ No_____ Other______________
Student________________________________Address:___________________________
Town_________________________Zip_______________Daytime phone:____________
Parent/Guardian______________________Work phone:__________Cell____________
Parent/Guardian______________________Work phone:__________Cell____________
Other emergency contact____________________ Phone: ____________Cell____________
Physician____________________________ Phone: ____________________________
Thank you very much for your cooperation.
Sincerely,
Linda Dame, RN
Head Nurse