RS Health Policy & Required Forms

Woodbury Jewish Center recognizes that certain students may need to carry and self-administer lifesaving medications, such as inhalers, epinephrine auto-injectors (EpiPens), or allergy pills. WJC does not employ medical personnel or have an on-site nurse, therefore students who require such medications may be authorized to carry and use them independently. 

● A completed Form A: Authorization for Independent Medication Carry and Use Form must be submitted and signed by the parent/guardian and the child’s licensed healthcare provider. 

● WJC staff are not permitted to administer routine or scheduled medications. 

● In the case of any emergency, staff will call 911 and then notify parent/guardian. 

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2. ALLERGY & ANAPHYLAXIS

WJC requires all families of children with severe allergies to complete Form B: Allergy and Anaphylaxis Emergency Care Plan. This individualized plan ensures staff are prepared to recognize symptoms and respond appropriately in an emergency. 

The Allergy and Anaphylaxis Plan must include: 

● Student’s name, date of birth, and emergency contact information. 

● Allergens (foods, insects, medications, environmental triggers, etc.). 

● Symptoms to watch for (hives, swelling, difficulty breathing, vomiting, etc.). 

● Specific medication to administer (EpiPen, antihistamine, inhaler, etc.) based on symptoms. 

● Clear instructions for when to administer medication and when to call 911. 

● Parent/guardian and healthcare provider signatures. 

Procedure 

The plan will be distributed to relevant teachers and staff. Staff will be trained in recognizing anaphylaxis and in emergency response protocols. Emergency response includes: 

1. Administering epinephrine (by student if able, or staff if absolutely necessary and authorized). 

2. Calling 911 immediately. 

3. Notifying parent/guardian.

WJC requires Form C: Individual Health Care Plan for a Child With Special Health Care Needs to be completed by the parent/guardian and healthcare provider. 

Plan Requirements Each plan should include: 

● Student’s name, date of birth, diagnosis, and emergency contacts. 

● Signs and symptoms specific to the child (e.g., low blood sugar, high blood sugar, seizure activity, asthma attack, for example). 

● Step-by-step instructions for staff to follow (e.g., “If student exhibits symptoms of low blood sugar, give 1 candy or juice box and call parent immediately.  Or, if student exhibits specific seizure activity, next steps to include, for example, positioning of student and/or staff administration of seizure rescue inhaler and call parent, 911 immediately.")

● Clear directives on when to call 911. 

● Any accommodations needed during programming (e.g., seating considerations, snack restrictions). 

Limitations 

● WJC staff cannot administer routine prescription medications.. 

● Staff may provide reasonable emergency support after adequate training by a licensed medical professional, including but not limited to giving candy for low sugar, positioning a child safely during seizure, calling 911, administering a first dose of Epipen or seizure rescue medications.