School Nurse » Medical Forms

Medical Forms

Children are required to have a physical examination prior to the start of school. The Universal Child Health Record must be filled out and signed/stamped by a doctor.  Any child who does not present proper documentation will be excluded from school beginning September 30th.
Please utilize the rest of the medical forms if needed for your child. Medication must be brought in by a parent/guardian and per state law, MUST be in the original pharmacy container with the original label.
Please note- Medication that is not picked up by the parent/guardian by the last day of school will be discarded. 
              * Please have your doctor complete the Food Allergy & Anaphylaxis Emergency Care plan.
              * Also, the parent must complete the 'Epipen Administration by a Delegate Form' 
                and the 'Food Allergy Plan of care- Nut free table form'
ASTHMA- please have your doctor complete the action plan below. Parent/guardian must also sign it. Send in asthma medication with form in the orignal pharmacy box. 
History of SEIZURES- Please have your doctor complete the 'Seizure Action Plan' and parent/guardian sign too.