(2) Medical Forms

Healthier students are better learners. We want to support your child’s health to make your child more successful inside and outside of school. To help manage your child’s health needs in school, we require you and your child’s health care provider to complete certain forms.

Health Records 
The following health documents are required to be submitted yearly by August 7th. Students with health forms not submitted prior to the first day of school will not be permitted to attend school, nor participate in field trips or athletic activities. Forms can be submitted online through the  PCD parent portal. 

Emergency Authorization

Student Health History

School Physical Form

In accordance with Rhode Island State laws, all students are required to provide proof of up-to-date immunizations or annual certificate of exemption before attending school. 

Immunization requirements and exemption forms can be found at https://health.ri.gov/immunization/for/schools/

Documentation can be emailed, faxed, or dropped off to the health office.


All medications, prescription or over-the counter, require a yearly medication authorization form. No medication will be administered without specific written instructions from the students parent and/or physician. 

Students may not keep medications (prescription or over the counter) in their possession during the school day. All medications with written authorization and instructions for administration, should be given to the school nurse. All medications, prescription and non prescription, should be in the original, properly labeled containers. 

Medication Authorization

Hours and Location

The Providence Country Day Health Office is located on the second floor of the Metcalf building adjacent to Corkery Auditorium. Nurse Costa is on campus Monday-Friday 7:30am-3:30pm. 

If your student requires medication during the school day or has a particular health concern please contact the school nurse:

Lisa-Mae Costa BSN,RN
401-438-5174 ext. 153
Fax 401-435-4514