Confidential Health and Support Questionnaire : Sexeys

Confidential Health Questionnaire

This medical questionnaire must be completed in full prior to start date. In order to safeguard all our students please note: Students are not allowed to carry any medication, homely, herbal or prescribed medication in school or the house. The Health Centre is easily accessible to all students, during term time and carries a wide range of homely remedies for symptomatic relief of most minor ailments. Therefore, there is no need for students to bring anything into school. If found they will be confiscated and destroyed. Students are permitted to self-administer medications; however, in all cases students must undergo a risk assessment by the Health Centre staff.

Pupil's name*

Forename Surname Preferred Forename

Sex*

Male
Female

Date of birth*

In the event of my child being ill or injured, I give permission for first aid to be given by a qualified first aider. In the unlikely event of the school being unable to contact me in an emergency, I give permission for my child to be taken to hospital and receive urgent medical, surgical or dental treatment, including x-rays and anaesthetic, as considered by the Doctors. I also give permission for my child to be seen and examined by the School Medical Officer and nurses, to be treated with prescription medications and weighed or measured if necessary.*

Tick to confirm

For the safety of Day and Boarding students

We stock a range of homely remedies to support students when they feel unwell and so parents do not need to supply these. All medication will be given age appropriate. Please can you check the list below and consent that you are happy that these can be administered to your daughter or son by the Health Centre or House Parents when appropriate. If this section is not completed we will be unable to administer these to your son or daughter without seeking your permission.

Please check the list of medicines below. If you would NOT like your daughter or son to be given a particular homely remedy please tick the relevant remedy.

I confirm that I am happy for my daughter or son to be given these medications or homely remedies if required as part of treatment of a medical need.*

Tick to confirm

Immunisation history

Please fill in the dates as accurately as you can or request and attach a print out from your GP: If we do not have the dates, we cannot continue their childhood immunisations when they are due.

D.T.P & HIB - 1

D.T.P & HIB - 2

D.T.P & HIB - 3

D.T.P & HIB - 4

D.T.P & HIB - 5

M.M.R - 1

M.M.R - 2

H.P.V - 1

H.P.V - 2

Men ACWY

Immunisation and booster information

Somerset Saint provide all school vaccinations or boosters for pupils during their time at Sexeys School. A consent form will be sent by email from Somerset SAINT and should be returned to them direct. Any questions should be sent to them direct. Sexey’s School provides the use of their hall for the vaccinations, but it is an external nurse team that comes into school to administer the vaccinations or boosters. Travel vaccines for Boarders can be arranged either through the G.P. surgery or a private clinic depending on which type of vaccination is required. All boarding students will be registered with Bruton Surgery, Patwell Lane, Bruton, so medical help is readily available while your child is with us. Should your child need to see your own local GP during the holidays or exeat weekends, then could you please state when you see the doctor that they are registered at Bruton surgery, and should only be seen as a “Temporary Resident”. In doing so, this will provide continuity of care, especially if your child is on regular medication or needs to be seen in an emergency.

I confirm that I have read and understood the information above*

Tick to confirm

Previous medical history

Has your child had any serious illness or injuries that led to an admission to hospital?

Does your child have any long-term or chronic medical or physical problems? E.g. asthma, diabetes?

Does your child have a history of a psychological condition for example an eating disorder, self-harm, depression, anxiety or any other?

4. Does your child have a learning difference, ADHD or Autism?

Does your child require any regular / daily medication?

Is your child covered by Private Health Insurance?

Is your child travelsick, suffers with hay fever, migraines, eczema, bed-wetting, period pain?

Does your child have any allergies, if yes please give details?

Does your child have any dietary requirements?

Does your child require hearing aids, glasses, dental braces or orthopaedic aids?

Does your child require any other professional help e.g. Speech and Language Therapy (SALT), Physiotherapy, Dietician, Orthodontist?

Is there anything else we need to know about your child that will help us to promote their health and well-being whilst in school?

Health Centre Information

All consultations are treated in a confidential manner by the doctor, health centre staff and counsellor. When a student is seen by a doctor or the Public Health School Nurse confidentiality is managed according to NHS guidelines. The Counsellor will follow their ethical code but all Staff employed by Sexey’s School have a duty of care to adhere to the School’s Safeguarding Policy, which is available on the School Website. The Health Centre is staffed by: Mrs Mora Sandiford RGN – Health Centre Manager Mrs Kathy Arnold – Health and Wellbeing Assistant Mrs Heather Sanger – Health and Wellbeing Assistant Counsellor – Mrs Carol Lesley. Routine dental and eye examinations should be made in holiday time if possible. The Health Centre provides: Advice on general health and wellbeing, Administration of Medications and arrangements for repeat prescriptions for Boarding students, Responds to sporting injuries and minor injuries Provides symptom relief for minor ailments, When appropriate compiles Care Plans for students with long term conditions, Regular health clinics, First aid cover and Counselling. Hospital referrals are made by GP surgery. Contraceptive advice is available from the Public Health School Nurse. Routine Immunisations are arranged through Somerset SAINT (School Aged Immunisation Nursing Team) and consent from parents will be obtained. There are facilities in the Health Centre for boarders who are unwell and unable to attend school. For students who are anxious or upset we provide a quiet room. When day students are unwell health centre staff will assess them and if needed will contact parents or guardians for collection from school. We are unable to send students home unaccompanied and advise that they are not left alone whilst unwell. You can contact the Health Centre on 01749 814146 or email healthcentrestaff@sexeys.somerset.sch.uk

I confirm that I have read and understood the information above*

Tick to confirm

Student support

In order for us to fully support your child when they join Sexey’s School in September, we would be very grateful if you could please complete these questions.

Has your child had any SEN support in the past?*

Yes
No

Does your child currently receive any SEN support?*

Yes
No

If yes, please can you provide further information

Does your child have an EHCP?*

Yes
No

Does your child have a confirmed diagnosis?*

Yes
No

If yes, please give details

Has your child ever received support from any external agencies (e.g. Educational Psychology Service/Learning Support Service/Advisory Service ASD/Hearing Support Service/Visual Support Service/SENIDAS) Please give details:

If you are a Forces family, have you left the forces in the last six years?

Yes
No

If you have answered yes, please add date of leaving forces

Is your child currently entitled to Free School Meals?*

Yes
No

Is your child adopted (out of Local Authority) or a child ‘Looked After’ by a Local Authority?*

Yes
No

Has your child ever had Free School Meals during KS2?*

Yes
No

Have you or your child been supported by Children Social Care*

Yes
No
Previously

If yes, please provide the name of your Social Worker

If yes, please provide the name of your Local Authority

Do you or your child have any support from the following agencies/services?

GetSet
PFSA
Any other support service agencies?

(please tick all that apply)

If you ticked other support agencies above, please provide details

Does your child require additional school visits?*

Yes
No

(Additional visit sessions can be arranged for the Summer term for students that have additional needs, who may have limited friendship links or worries/concerns about school transition).

I confirm that all the information given is correct and accurate as of today's date.*

Tick to confirm

Name*

Title Forename Surname

Date*