School Nurse » Medical Forms

Medical Forms

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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.
It is recommended that all students have an annual physical.
 
Please utilize the following medical forms if they pertain to 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. 
 
FOOD ALLERGIES:
              * 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. Parent must bring in the asthma medication  (in the ORIGINAL pharmacy box) with the completed asthma action plan.
 
History of SEIZURES- Please have your doctor complete the 'Seizure Action Plan' and parent/guardian sign too.