NURSE’S NOTE: ILL CHILD AT SCHOOL
NURSE’S NOTE: ILL CHILD AT SCHOOL
Date: ______________
Student: Grade Room _________
Temperature: __________
Ears: RT. ________ LT. ____________ Ringing Draining
Throat: _______________________ Difficulty with swallowing
Coughing: yes no Productive: yes no
Right Eye: clear red runny burning itching
Left Eye: clear red runny burning itching
Nose: runny stuffy clear
Tired: yes no Listless: yes no
General Body Aches: yes no Pain in the:
Headache: yes no
Nausea: yes no
Vomiting: yes no number of times
Skin: itching rash sore lesion
Other: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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