Nurses

Grade Level	Nurses' Page & Extension	Important Documents & Forms
High School	Lisa Lottermann, RN:  x 3056 Athletic Trainer, John Conway, ATC: x3133	Asthma Action Plan Epi-Pen Emergency Health Care Plan Pre-Participation Physical Exam Form (Parts A & B) Please Note: This form must be used for all pre-participations physicals conducted beginning May 1, 2010.  No Exceptions.	Health Update form/Repeat Athlete Form (Part C) Medication Authorization Request NJSIAA Parent-Guardian Concussion Policy Acknowledgement Form
Middle Schools	East Brook: Christine Ilenko, RN:  x 8126 West Brook: Nancy Fox, RN:  x 8222	Asthma Action Plan     Inhaler: Self Administration Authorization (Fill out and Submit Form on Page 2)  Medication Authorization Form   Physical Exam Form	Epinephrine - Letter to Parent Epinephrine Delegation - Statement of Authorization Epinephrine Emergency Health Care Plan
Elementary Schools	Memorial: Maryanne Certosimo, RN: x 8320 Midland: Catherine Alvarez, RN: x8414 Parkway: Elaine Palombit, RN: x8518 Ridge Ranch: Linda Broek, RN: x8616 Stony Lane: Gina Kaider, RN: x8716	Asthma Action Plan Inhaler - Self Administration Medication Authorization Request Physical Exam Form	Epinephrine - Letter to Parent Epinephrine Delegation - Statement of Authorization Epinephrine Emergency Health Care Plan

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145 Spring Valley Road  ♦ Paramus, NJ 07652 ♦ 201-261-7800