Health Services

Welcome to RSU 5 Health Services

 Welcome to the Health Services web page.  This web page is designed to introduce you to health services in RSU5, resources to district and health requirements, and information on common childhood illnesses.  RSU5 is dedicated to the health and well being of the students in our district.

What does my child need for school registration?


Pre-k K-12  
4 5 DPT (4 if the 4th dose is given after the 4th birthday)
3 4 OPV (3 if the 3rd dose is given after the 4th birthday)
1 2 MMR (the 1st dose is given on or after the 1st birthday)
1 1 CHICKEN POX  (vaccine date, disease date, or blood test result)
  1 Tdap Booster (for students entering 7th Grade)
  1-2 Menactra (for students entering 7th Grade, 2nd dose by 12th grade)

If you have philosophical, medical or religious reasons for not vaccinating your child, please click on the following link to follow state law requirements.    LINK TO FORM (Immunization Exemption Form)


For more detailed information about immunization state law please refer to the following link:

State of Maine Immunization Law   Immunization Requirements for School Children (Joint Agency Rule of the Maine Department of Education (Chapter 126) and the Department of Health and Human Services Maine Center for Disease Control and Prevention(Chapter 261) (revised Dec. 2016


 We ask parents to fill out a health history form on each child upon entering Prek, and K or when a child transfers into the  school district. We then require parents to fill out an abbreviated health update each year on each of their children. Having updated medical information helps us to provide your child with the best care possible. We are only able to do this if we have accurate and current information.  We are always here to help. Below are the links to the district health forms.


Health History form (student health history)


Annual Health Update

 It’s important for children to have regular well-child checks with their health care provider.  It is the policy of our district that A copy of this physical exam form be provided to the school nurse during the following intervals; for students entering Pre-K, Kindergarten, 3rd, 6th, 9th,  & 11th Grades and all Transfer Students. This form also serves as the required athletic clearance for students who wish to participate in sports. Below is the link to district Physical and Athletic Exam form that is to be competed by your healthcare provider.

Physical Form

Athletic Exam Form


What if my child needs medication at school?     

Medications should be given at home when possible. In the event your child requires medicine at school you will need to complete the medication permission form and bring the medicine in the original bottle (this will serve as the health care providers signature).   Add link to the permission form (Medication Permission Form)

For over the counter medicines; our policy states a medical provider must prescribe these medications in order for them to be given at school. If your child has a condition that warrants over the counter medicine frequently please speak with your provider to obtain a prescription to help us comply with this policy. These also need to come to school in original containers.

Maine state law allows students to self carry emergency medicines, at the discretion of the school nurse, with proper documentation. This needs to be indicated on the health plan with signatures from doctor and parent.

Medical/Allergy Plans need to be updated each year. If your child has a medical condition or severe allergy that requires a health plan please speak with your provider to obtain an updated plan each school year.  If we don't have an updated form for your child, we can not use the plan from the previous year. We will assume your child no longer has the need for the plan.

For more information on state law related to medication at school please refer to the following link:

Maine DOE Rule Chapter 40 - Rule for Medication Administration in Maine Schools (revised May 2016


What Health Screenings are done in school?

It is important to identify students who may have hearing and/or vision deficits. The impact on their learning may be significant if there is a problem that goes undetected. Students may not be able to recognize for themselves that something is wrong and compensate in ways that may look like behavior issues or learning disabilities.

Vision Screening will take place in Pre K, K, 1, 3, 5, 7, and 9th grades

Hearing Screening will take place  Pre-K, K, 1, 3, and 5th grades

If a problem is suspected you will be contacted.

Some schools may also do a height and weight screening.


For more detailed information about school health screenings please refer to the following link:


Maine DOE Rule Chapter 45   Rule for Vision and Hearing Screening in Maine Public Schools - effective April 1, 2006


All forms and health plans are available in the main office or click on the following links:

Health Requirement Forms
Student Health History (for Pre-K, K and transfer students)
Student Annual Health Update

Student Physical and Athletic Exam
Medication Permission Form
Immunization Exemption Form
Asthma Action Plan
Anaphylaxis Action Plan
Seizure Action Plan
Concussion Return to School Form


Parent Resources

These are a few of the evidence based resources that we frequently refer parents and staff to with questions about some of the more common health concerns. Feel free to contact us if you have questions that are not answered here, would like further information, or are having difficulty finding information on a topic that may not be listed here.



Asthma School Plan (pdf)

Immunization Exemption Form

Seizure Action Plan (pdf)

Medication Permission Form (doc)

Pertussis FMS CDC Parent Letter (pdf)

Pertussis in Schools FAQ (pdf)

Pertussis Fact Sheet (pdf)

Make It Your Business to Fight the Flu (doc)

FLU Clinic SLVC Health Screen Permission Form (pdf)

SLVC 2012/13 VIS Flu Live (pdf)

SLVC 2012/13 VIS Flu Live (pdf)

Allergy Plan (pdf)

Health History Form




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