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Claremont Elementary School

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School Nurse

School Nurse PNG

Maribeth Virzi, BSN, RN, CSN

(P) 732-210-3500 X15500

(F) 732-422-5928

Email Maribeth Virzi, BSN, RN, CSN

Clariss Flournoy, BA, LPN

(P) 732-210-3500 x15506

(F) 732-422-5928

Email Clariss Flournoy, BA, LPN

Medical Forms

  • Nursing Services Plan

  • Child Health Record Form

  • Authorization for Administration of Medication

  • Asthma Treatment Plan

  • Asthma Treatment Plan Student Parent Instructions (page 2)

  • Authorization for Administration of Epinephrine

  • Allergy and Anaphylaxis Emergency Plan

  • Allergy and Anaphylaxis Emergency Plan (page 2)

  • Dental Exam Record

  • Health History Form (Parents Must Complete Yearly)

  • Seizure Action Plan

  • Student Accident - Procedures

  • Student Accident - Report Form

  • Student Accident - Insurance

  • Home Instruction Form

  • NJ Family Care Health Insurance-Spanish

  • NJ Family Care Health Insurance-English

  • Mandatory Immunization (Medical Exemption Information)

  • Religious Exemption Certification Form

  • Universal Child Health Record

  • Physician's Form for Home Instruction

  • FERPA Form

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Claremont Elementary School  175 Claremont Road  Franklin Park, NJ 08823
Number: 732-210-3500   

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