Health Office Forms
|Health Office Forms
Click the links below to download the
following Health Office forms
||All students who have
an epinephrine injection device ordered for a severe
allergic reaction must have this Allergy Action Plan completed and
signed by their physician. The parent/guardian must complete the
back of the form and sign it. The form is then submitted to the
nurse along with the medication that has been ordered.
||This form must be completed by the child's
doctor and signed by a parent/guardian before medication can be
administered during the school day.
||All students using asthma medication while at
school must have this asthma treatment plan completed and signed by
their physician. A parent/guardian must also sign the form, &
return to the school nurse with the medication.
||This form must be completed by a student's
healthcare provider and submitted as part of registration (the exam
must have been done within one year before entrance to school) and
for documenting annual exams.
|This form must be completed annually by the
student's parent/guardian and returned to the school.