Health Forms and Services

As you prepare for the 2016-17 school year, please refer to this helpful health form checklist.

Also, if your annual insurance-provided physical is not available until after the start of the school year, we suggest these low-cost alternatives.

Our requirements are consistent with both Maryland State law and our commitment to encouraging good health and well-being for our students. As your son’s information will be submitted in various forms, we thank you in advance for your patience and close attention to detail.  Please note that health information documents requiring the signature of a physician must be submitted on paper. All students are required to provide health forms prior to or during orientation. Students trying out for fall sports must submit forms prior to or on the first day of practice. 

Required Health Information & Forms:

Medical History and Physical - Access Form
Physicals for the 2016 – 2017 school year should be completed between May 1 and orientation.  The two-page document gives the school a summary of your son’s medical history and his present physical well-being. A copy is enclosed; it is also available online. Students trying out for fall sports must submit health requirements prior to or at the first day of practice.

Immunization - Access Form
All students must submit a copy of their immunization record. If there are new immunizations or boosters, a new form should be sent to Loyola.

Other Forms (if applicable):

Over-the-Counter Medication Consent (not required, but recommended) - Access Form
Completion of this form allows the School Nurse to administer over-the-counter medications to your son to alleviate symptoms such as headache, upset stomach, etc.

Prescription Medication Consent - Access Form
This form permits the School Nurse to administer prescription medications that your son takes during the course of a school day. One form for each prescription must be provided and signed by a doctor.

Health Action Plans
If your son has a condition such as severe allergies, asthma, diabetes or seizures, please submit a Health Action Plan form. This document provides specific information to help facilitate the appropriate actions in the event that your son requires treatment while at school. 

Action Plan for Seizures   Action Plan for Diabetes   Action Plan for Allergies   Action Plan for Asthma

Supplemental from for Student w/Insulin Pumps


Forms may be dropped off over the summer to the Health Form Drop Box located in the Dean of Students’ Office in Knott Hall. Please do not hand-deliver forms to anyone. 

Forms also may be mailed to:

Loyola Blakefield
c/o Mrs. Robin Schwartz, R.N.
P.O. Box 6819
Baltimore, MD 21285-6819

Please direct questions by email to the School Nurse, Mrs. Robin Schwartz, R.N. During the summer months, Mrs. Schwartz will respond to emails on a weekly basis. For urgent issues, please email Mr. Bob Schlichtig, Dean of Students.