490 David Terrace, Union, NJ 07083
Phone: 908.851.6570
Fax: 908.687.5741
Mrs. Maryam Holder

Please contact me with your health questions or concerns.

What follows is some general information that may be of interest to you.

Keep your child from getting and spreading ENTEROVIRUS D68

You can help protect your family and yourself from respiratory illnesses by following these steps:

  • Wash hands often with soap and water for 20 seconds, especially after using the bathroom or changing diapers
  • Avoid touching eyes, nose and mouth with unwashed hands
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
  • Disinfect frequently touched surfaces, such as toys, desks, computer keyboards, cell phones, and doorknobs, especially if someone is sick.


For more information on ENTEROVIRUS D68: http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html


New Fall Sports Physical Info 2016-17

The health care provider that does your sports physical must complete the Student-Athlete
Cardiac Assessment Professional Development Module, or the school cannot accept the
physical exam. Please share this information with your health care provider, and make sure
that the provider signs the certification statement on page four of the physical exam packet.
If this is not signed, the physical cannot be accepted, and will be returned to the student.
To: Health Care Providers Performing Student Sports Physicals
SUBJECT: Student-Athlete Cardiac Assessment Professional Development Module
The New Jersey Department of Education (NJDOE) is pleased to announce the availability of the
Student-Athlete Cardiac Assessment professional development module (PD module) required by
the Scholastic Student-Athlete Safety Act (SS-ASA) (N.J.S.A. 18A:40-41.7). The PD module can
be found at
The SS-ASA requires that:
• The PD module be completed by the physician, advanced practice nurse (APN), or physician
assistant (PA) who performs a student-athlete’s annual physical examination prior t
o the
student’s participation on a school-sponsored interscholastic or intramural athletic team or squad
in grades six through 12 (N.J.S.A. 18A:40-41.7);
• Upon performing a physical examination, the physician, APN or PA shall sign the certification
statement on page four of the Pre-Participation Physical Evaluation (PPE) form attesting to the
completion of the PD module. The physical exam packet can be viewed at
(N.J.S.A. 18A:40-41d);
During the summer, please bring your completed physicals to UHS Main Office, so they can be
processed immediately. Do not send them to Kawameeh Middle School because the School
Nurse will not get them until school starts again in September.

Top 10 Reasons That Delay Your Sports Physical

 Missing/Unsigned Health History Questionnaire (page 1, History Form)

 You must explain the reason why you answered “yes” to any question on the Health History Questionnaire (page 1)

 (page 3, Physical Examination Form, *Must be documented in numerical terms, e.g. “normal” or “cleared” is not acceptable.)


*Blood Pressure


*Vision (If you have prescription contact lenses or glasses please wear them for your eye exam. If your vision is 20/40 or higher you will need to see an eye care professional for correction)

Physical Examination Form is not signed by health care provider (page 3)

 Physical not dated (bottom of page 4, Clearance Form)

 Clearance Form is not signed and stamped by health care provider (page 4)

 Health Care Provider has not signed that they completed the Cardiac Assessment Professional Development Module (bottom of page 4, Clearance Form)

 Physical will expire before the official start of the season 

 Missing 90 Day Health History Update Questionnaire

 Missing/Unsigned Concussion, Sudden Cardiac Death, and Steroid Testing Acknowledgement Form (page 5)


Missing information will cause a delay in clearing you to participate in your sport. Do not leave any lines blank, including your name, address, and date of birth.     

Check your sports physical packet BEFORE YOU HAND IT IN FOR CLEARANCE!!!  

Gym excuses:

A parent may write a note to excuse a student from participation in gym for a maximum of two days. If your child needs to be excused from participation in gym for more than two days, you should have them evaluated by a physician. The student must bring a doctor's note to the school nurse stating the diagnosis and length of time the student will need to be excused from gym. If the doctor's note states "excused until further notice," the student will be excused until the date of the next doctor's appointment for re-evaluation.


If your child has asthma, they must have an asthma treatment plan on file with the school nurse. The form must be signed by the student's doctor and the parent. If the parent and the doctor agree that the student is capable of self-administration of their inhaler, the proper box must be checked at the bottom of the asthma action plan to indicate this. The student may then carry their inhaler with them in school after they show it to the nurse. It must be labeled with the student's name. If the student requires supervision to use their inhaler, it must be stored in the nurse's office. The Asthma Treatment plan can be printed from this site: http://www.pacnj.org/pdfs/asthmatreatmentenglishfillable.pdf. More information about asthma and children can be found on this site: http://www.pacnj.org/plan.html


All students entering grade six must have these vaccines:

  • Tdap - All children born on or after January 1, 1997 and enrolled in Grade Six must receive one booster does of the (Tdap) Tetanus diphtheria and pertussis vaccine, provided 5 years have lapsed since the last dose.
  • Meningococcal vaccine- All children born on or after January 1, 1997 are to receive one dose of meningococcal-containing vaccine when entering Grade 6.
A copy of your child's official vaccine record completed by your health care provider must be presented to the School Nurse, or your doctor must write the name of the vaccines and the date administered on a prescription note to be given to the School Nurse.

If you have no health insurance, or your insurance does not cover vaccinations, a Free Immunization Service is provided by Union County Immunization Center 908-965-3627; or Township of Union Child Health Clinic 908-352-1200 ext. 4209.

Please notify the school nurse once you make your appointment. You must have a referral from the School Nurse for the Union County Immunization Center.

Handwashing is the best prevention from spreading illness. Keep this in mind when you celebrate the holidays with family and friends, and stay healthy!