Student Medical Form – International School for Medical Science and Engineering

Student Name (as per QID)(Required)

Date of Birth(Required)

(dd/mm/yyyy)

Grade Level(Required)

Gender(Required)

Blood type(Required)

Nationality(Required)

Parent Contact Information

Father Name(Required)

Mobile No.(Required)

Mother Name(Required)

Mobile No.(Required)

Does your child have any allergy?(Required)

Yes

Please indicate the kind of allergen/s.(Required)

What medication/s does your child take in case of an allergic reaction?(Required)

Does your child have asthma?(Required)

Yes

What medication does your child take in case of an asthma attack?(Required)

Does your child’s immunization shots are updated?(Required)

Yes

Attach copy of the immunization record(Required)

Max. file size: 80 MB.

Does your child had history of any infectious disease? Please tick below(Required)

Does your child have any other medical conditions that the school needs to be aware of?(Required)

Yes

Please attach a medical certificate indicating the medical diagnosis.(Required)

Max. file size: 80 MB.

In case of emergency please contact:

Name(Required)

Mobile No.(Required)

Relationship(Required)

Please be informed of the following:

When your child is sick (fever, vomiting, diarrhea, or loose motion), we will contact you to collect your child as soon as possible. While waiting, your child may remain in the school clinic.
If your child is sick, please do not send him/her to school. Allow your child to rest at home and send an email to attendance@ismeqatar.org. A medical certificate or a parent letter must be submitted to the nurse upon your child’s return in order to mark the absence as excused.
Prescription medication (e.g., antibiotics, etc.): If your child requires medication during school hours, you must complete a Consent for Medicine Administration Form (available in the clinic) and provide the medicine properly labeled. Without consent, no medicine will be administered.
In the event of an accident or emergency requiring hospital care, we will immediately contact you. If, despite all efforts, you are unreachable, your child will be sent to Hamad Hospital by ambulance, accompanied by a school staff member.

Parent Permission to Administer Over-the-Counter Medication(Required)

Please tick oral over the counter medicine/s that you allow your child to be administered in the school clinic.(Required)

Paracetamol / Acetaminophen (Panadol Advance) – for pain, fever, period cramps

Ibuprofen (Advil, Brufen) - for high fever, pain, swelling, period cramps

Lozenge – for sore throat

Antacid (Maalox) – for indigestion, gas pain

Antispasmodic (Buscopan) – for stomach cramps, bladder spasm

Anti diarrhea (Immodium) – for loose motion

Antihistamine (Claritine, Zyrtec) –for allergic reaction

Cold medications (Panadol Cold And Flu ) – for congestion / colds

I DO NOT ALLOW MY CHILD TO BE GIVEN ANY ORAL OVER THE COUNTER MEDICINE IN SCHOOL

Parent signature(Required)

Accepted file types: jpg, jpeg, png, Max. file size: 80 MB.

Date(Required)