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Derry Township School District

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A Community Cultivating an Extraordinary Learning Environment

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  • Heath Services Forms

Health Services

  • Overview
  • School Medical Care
  • Communicable Diseases
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  • Medication Drop Off Day
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  • Keep the School Informed
  • Physical & Dental Examinations
  • Heath Services Forms
  • Medication Policy
  • What is BMI?
  • Immunization Schedules 0-6 years; 7-18 years
  • School Immunization Requirements
  • DTSD Sunscreen Permission form
  • Anaphylaxis health plan and Epinephrine physician order form page two

    Anaphylaxis health plan and Epinephrine physician order form page two

    epi pen page 2.pdf 54.9 KB (Last Modified on August 31, 2022)
    Comments (-1)
  • Anaphylaxis Health Plan and Epinephrine Physician order form

    Anaphylaxis Health Plan and Epinephrine Physician order form

    epi pen page one.pdf 83.78 KB (Last Modified on August 31, 2022)
    Comments (-1)
  • Private Dentist Form

    Private Dentist Form

    A dental exam report is state mandated for all students in grades K or 1, 3, 7, and new students.  Please return completed forms to the certified school nurse in your child's building.

    Private_Dentist_Report1.pdf 48.68 KB (Last Modified on August 10, 2011)
    Comments (-1)
  • Private Physical Examination Form

    Private Physical Examination Form

    A physical examination is state-mandated for students in grades K or 1, 6, 11, and new students.  The examination may be completed in the year before or during the above-indicated grades.  Please return completed forms to the certified school nurse in your child's building.

    PADOH PHYSICAL EXAM approved 10-11-12.pdf 194.87 KB (Last Modified on August 15, 2016)
    Comments (-1)
  • School Medication Form

    School Medication Form

    Use this form to provide information on any medications to be administered during the school day. A written Physician's order is required for any prescription medication or over the counter medication to be administered during school hours. 

    DTSD MEDICATION ORDER.doc 122 KB (Last Modified on March 15, 2019)
    Comments (-1)

Address

P. O. Box 898
30 E. Granada Avenue, Hershey, PA 17033

Phone

(717) 534-2501

Fax

(717) 533-4357

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