LJA Health Requirements
*K-12, Main Campus – hand in forms to the LJA School Nurse at Front Office for review
Hawaii law requires each student to present a report of a physical exam, a certificate of TB exam, and a record of immunizations with the signature or stamp of a U.S. licensed Medical Doctor (MD), Doctor of Osteopathy (DL), Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA) dated no later than one year from the start date of school.
Student transfer from a Hawaii school - needs to submit a physical exam, TB certification and complete immunization record prior to entrance into LJA.
Student transfers from out-of-state or out-of-country - regardless of prior school attendance in Hawaii, must complete a physical examination & TB certificate dated no later than one year from the start date of school, as well as, an up-to-date record of immunizations before attending school.
A student who has not completed the physical exam or all the required immunizations may be allowed a provisional attendance ONLY upon submitting a medical appointment card or letter from a practitioner showing that the student is in the process of obtaining the required immunizations(s) or physical exam.
A student may not attend school without a valid TB certificate -- The TB certificate may not be deferred.
▪ Tuberculosis (TB) Clearance --- NO TB, NO ADMITTANCE !!!
- A certificate of TB examination must be presented prior to first attendance at a Hawaii school.
- A valid certificate of TB examination must be issued within 12 months prior to first attendance at a Hawaii school. This requirement may not be deferred or postponed
- If the diameter of induration is 10mm or greater, a chest x-ray must be provided prior to first attendance at school in Hawaii. See Department of Health requirements for TB certification if the results are 10mm or greater (website & phone number below).
▪ Physical Examination (Student Health Record/Form 14)
- Each student must have a physical examination and all required immunizations within 12 months before first attending school in Hawaii.
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The exam must be performed and signed by a U.S. licensed Medical Doctor (MD), Doctor of Osteopathy (DO), Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA).
▪ Health Room Emergency Form – COMPLETED YEARLY
- Each student must have a new form completed by July 1st each school year & turned into the school nurse.
▪ Medication Forms
- Students needing medication at school must have a form completed and on file each school year.
- Students with asthma need to complete the Asthma Form (see below)
▪ ILH Athletic Participation Form (Grades 7-12 only)
Where do I turn in the forms?
Main Campus, K-12: Mail to Le Jardin Academy, attention: Health Room or drop off at Main Campus front office, nurse’s desk.
Junior School, PK-JK: drop off at the Junior School front office or mail to mail to Le Jardin Academy, attention Junior School health.
What if I still have questions about my child’s Health Requirements, Forms or health issues?
Main Campus, K-12:Elaina Hall/RN, LJA School Nurse at ehall@lejardinacademy.com,
261-0707 X242 or Denise Price-Nakagawa, front office receptionist 261-0707.
Athletic Director Assistant: Jen Oiness @ joiness@lejardinacademy.com 261-0707 x1140
Junior School, PK-JK:- Lauren Nakayama, Administrative Assistant at lnakayama@lejardinacademy.com
Links: School Year 2009-2010
1) Health Room Emergency & Medication Form, PK-JK
2) Health Room Emergency & Medication Form, K-12
3) Form 14/Student Health Record (Physical Exam, TB Clearance, Immunizations)
4) Prescription Medications, Including Self-Administered EpiPen & Inhaler
5) Administration of Over-the-counter Medication (not provided by school)
6) Anaphylaxis Emergency Action Plan
7) ILH Athletic Participation Form (2 pages)
Dept. of Health Examination & Immunizations: http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-157.pdf
Or call Hawaii Immunization Program (O’ahu) (808) 586-8332
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