Medical Forms for New Families

CTTCS Health Requirements

My name is Chriss Zimmerman, and I am the school nurse for Christ the Teacher Catholic School. I am very excited to have this opportunity to provide a safe and healthy environment for your child . I will be working with you, your child, and the school staff to address any health needs or special concerns your child may have.

Medical Records

Delaware has mandated that all children upon original entry into a school provide documentation of the following:


  • DPT (DtaP) x 5 doses unless the 4th dose was given after the 4th birthday
  • IPV of OPV x 4 doses unless 3rd dose was given after the 4th birthday
  • MMR x 2 doses – usually first dose given after the age of 12 months, second dose after the 4th birthday
  • Hepatitis B – 3 doses
  • Varicella (chicken pox) x 1 dose or a written disease history


Current, within two years prior to entry into school

Health Forms

Dental Form

Dental Form

Physical Exam Form

Health Form – Grades PreK-6

Health Form – Grades 7-8


Results of Mantoux screening complete within the past 12 months or assessment as recommended by Delaware Division of Public Health

Lead blood test

Usually done around 12 months of age

During the School Year

I am available in the school 5 days a week and will be assisting your child with any healthcare needs. Communication with parents/guardians is such an important part of my job. In order to best help your child, I need to know if your child has any specific medical problems. These may include allergies, medications, or chronic conditions. Also, if anything changes with your child throughout the year, such as a medication change, please let me know as soon as possible. Medication can be given to your child while they are at school. You will be requested to sign a medication authorization form if your child must take prescription medication during the school day. The medication must come to school in its original container with the prescription label attached and will be kept my office. Nonprescription medication (acetaminophen, Ibuprofen, antacids, etc) may also be given to your child. However, a nonprescription medication form must be completed and signed by you and your child’s physician.

Thank you for entrusting your child with us. I look forward to working with your child to keep them healthy so they can concentrate on learning!