February
8, 2017
Dear Parent/Guardian:
Your seventh grade child is scheduled to have
a school health examination under the authority of Massachusetts General Laws,
Chapter 71, Section 56. All children in
grades three, seven and ten are required to have a current, completed physical
exam on file in their school health record.
Your family physician
has comprehensive knowledge of the health status of your child. Therefore, we strongly feel that your own
physician should complete this examination.
If this exam is completed by your physician, please return a copy of the
completed physical form to the school nurse.
If your child is
unable to see a physician of their own, we are offering incoming seventh grade
physicals at the Memorial Middle School in the spring by the school physician,
Dr. Martin Iser. There will not be a make-up session. This physical may include any of the body
area, such as head, chest, abdomen, external genitalia, and extremities, as
well as other areas listed on the attached form.
Parent/Guardian must
fill out the medical questionnaire on the attached form, sign the permission
slip below and return both to the school nurse by Friday, March 3, 2017.
Sincerely,
Sharon
M. Striglio, R.N.
School
Nurse
________________________________________________________________________
I give permission for
my son/daughter, ________________________, to have their physical examination
by Dr. Martin Iser at the Memorial
Middle School
Parent/Guardian
Signature Date
My son/daughter,
______________________, will be examined by our family doctor on
_____________________. I will return the
completed form to you at that time.
Parent/Guardian
Signature Date
