Nurse/Health Forms

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Shamrock Gardens Elementary
Magnet School of Excellence

3301 Country Club Drive
Charlotte, NC 28205
Courier #: 527

P: 980-343-6440 | F: 980-343-6513

Principal: Waltrina Potter

LC: East
Bell Schedule: 8:00 AM - 3:00 PM
Grades: PreK-5

Email School

Nurse/Health Forms

If your child has a health condition, please complete the appropriate forms (linked below) with your doctor and return promptly to the school EACH SCHOOL YEAR. You can reach SGE's school nurse at 980-343-6440 with any questions.

Please be aware of the following CMS policies:

- ALL medications (both prescription and over-the-counter) MUST have a Medication Authorization Form, signed by a doctor, on file in the Health Room in order to be brought to school.

-Children are not allowed to carry ANY medications without a doctor’s and school administration’s written permission. This includes Epi-Pens, asthma inhalers, over-the-counter medications.

In order for children to enter school in North Carolina, they must have up-to-date immunization records and a health assessment. Click here for more information and to download forms: (opens in new window)

(opens in new window)

Asthma Action Plan 4 21 2017 (1).pdf

Asthma Checklist.pdf (opens in new window)

CMS Diet Order.pdf (opens in new window)

Diabetes Checklist 2018.pdf(opens in new window)

Diabetes MD Order and Care Plan.pdf (opens in new window)

DiastatMDOrder.pdf (opens in new window)

Generic MD Order (1).pdf (open in new window)

Hemophilia Emergency Action Plan.pdf (opens in new window)

Medication Authorization MD order 2018.pdf (opens in new window)

Seizure Emergency Action Plan.pdf (opens in new window)

Severe Allergy Emergency Action Plan.pdf(opens in new window)

Sickle Cell Emergency Action Plan.pdf (opens in new window)

P.O. Box 30035
Charlotte, NC 28230-0035
Phone: 980-343-3000

The Charlotte-Mecklenburg Schools website (www.cms.k12.nc.us) is in compliance with Section 504 of the Rehabilitation Act and Title II of the Americans with Disabilities Act. Any website accessibility concerns may be brought via the following, Email the Web Accessibility Team at WebAccessibility or Call: 980.343.0115. In compliance with Federal Law, Charlotte-Mecklenburg Schools administers all education programs, employment activities and admissions without discrimination against any person on the basis of gender, race, color, religion, national origin, age, or disability. Inquiries regarding compliance with Title IX of the Education Amendments of 1972, which prohibits discrimination on the basis of sex in education programs or activities, may be referred to the District's Title IX Coordinator at titleixcoordinator or to the Office for Civil Rights, United States Department of Education.