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Samoset Middle School

Nurse/Medical Forms

Phone 631-471-1700
FAX 631-471-8912


Mrs. Pat Miller R.N

Mrs. Lisa Dellegar R. N. 



Physicals— All 7th grade students must have an exam by a physician. This is New York
State Law. If a physical isn’t handed in, the school doctor will provide the physical.
*New Body Mass index must be included in all 7th grade physicals.

Medications— The nurse can dispense medication during the school day with parents
permission and a doctor’s note. Students are not permitted to carry medication unless a
self directed form is signed by the doctor.

Sports— All students participating in sports must have a sport physical. It is completed
by a private doctor or the school doctor on the sports physical form. Pick up forms in the
nurse’s office. It must be done on Sachem’s sports physical form or it will not be
accepted. Parental permission must be signed in the front of the form. The school doctor
will be here to do sports physicals before each season starts. Dates will be announced.

Immunizations— All students entering the 6th grade must have proof of varicella (chickenpox) disease or immunization. They must also have proof of Tdap vaccine.

Green Cards— They are to be filled out for those students who already have tried
out for a sport. All questions must be answered and signed by a parent or guardian

All students using crutches must have a doctors note.
All students reporting to the nurses office must have a pass.
All parents and guardians must bring a picture I.D. when a student is released.
All 7th graders will have a vision and hearing test.
All students must have a scoliosis screening