Health 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.