Health Services

At the North Shore Hebrew Academy, we are committed to keeping our students healthy and safe. Below is where you’ll find important school policies, referral forms, and health notices.

NSHA Nurse Contact Information

Cherry Lane (Grades PreK-5)

Tanaz Banilivi, R.N.
TBanilivi@nsha.org
Tel: (516) 487-8687 Ext. 115
Direct Fax: (516) 487-5565

Old Mill Road (Grades 6-8)

Mrs. Swerdlin, R.N.
BSwerdlin@nsha.org
Tel: (516) 487-9163 Ext. 215
Fax: (516) 829-3933

Forms

100 - Health/Medical Information (STUDENT)

100 – Health History
102 – Physical Exam Form
103 – “A” Form
104 – “B” Form and NYS Concussion Information
105 – Dental Health Report
109 – Confidential Health Concerns
110 – Pre-School Lead Screening Requirement

200 - Immunization Forms

200 – Immunization Record
202 – Immunization MMR#2 Requirement
203 – Immunization Chicken Pox Requirement
204 – Immunization Tdap Requirement

300 - Medication Forms

300 – NYS Guidelines for Administration of Medication
301 – Parent Authorization for Medication
302 – Physician’s Order-Parent Authorization for Medication
303 – Self Medication Release Form

400 - Referral Forms

401 – Vision Referral
402 – Vision Referral Update
405 – Hearing Referral
407 – Scoliosis Referral

500 - Assistive Device Forms

501 – Guidelines for Protective/Assistive Devices
502 – Guidelines on Using Crutches
503 – Assistive Device Note – Parent

700 – Exposure Notices

710 – Chicken Pox
711 – Conjunctivitis
712 – Coxsackie Virus
713 – Fifth Disease
714 – Impetigo
715 – Shigellosis
716 – Pediculosis
717 – Streptococcal Infection

900 – Miscellaneous

904 – Elementary Health Office Numbers
905 – Release of Confidential Information
Department of Health Survey Parent Letter