Medical Forms

http:PDF Forms are available to print in English and Spanish (click on the forms below)


ALL forms are required to be completed by a medical doctor (MD), nurse practitioner (NP), physician’s assistant (PA), or any other medical provider authorized to prescribe medications and/or diagnosis health conditions and/or injuries. Please turn in all forms to the Credentialed School Nurse (CSN) or authorized health staff. If you have any questions or need assistance, please contact the Credentialed School Nurse, or the authorized health staff at the school site in which your child attends.

 

Request for Medication Administration at School: This form is used for any medication a student is required to take during school hours. Medications include: over-the-counter (OTC) such as Tylenol, Motrin, or Benadryl; prescribed medications for diagnosed health conditions, such as ADHD, Asthma, Diabetes, Multiple Sclerosis, Seizures, Migraines, etc. Medication kept in the health office must have the student’s name, drug name, drug dosage, and expiration on the bottle. With the exception of inhalers and epi-pens, ALL medications must be kept in the health office. Form(s) must be completed annually on a school year basis. Click here for English Click here for Spanish. Click here for Asthma Action Plans.


Recommendation for Limited Participation in Physical Education: This form is grade-specific and used when a student is injured and cannot participate in a regular PE class, sports, recess, or academic courses. Please turn in forms immediately to ensure proper placement. Click here for grades K-6. Click here for grades 7/8. Click here for grades 9-12.


Report of Health Examination for School Entry: This form is required for all students entering 1st grade. Physicals completed 18 months prior to 1st grade are accepted. (For example, if you have a Kindergarten student who completed a well-child check in March 2021, the physical exam will be counted for the 2021-2022 school year.) Click here for English/Spanish.


Waiver of Health Examination for School Entry: A waiver is used when a parent chooses not to have their student received a health examination or cannot obtain an examination in the required time frame. Please see the Credentialed School Nurse (CSN) for assistance. Click here for English/Spanish.


Oral Health Assessment Form/Waiver of Oral Health Assessment Requirement:This form is required for all Kindergarten students and any 1st grade students who have not attended Kindergarten. Section III of the form is for the waiver if the parent is unable to find a dental office, cannot afford a dental exam, or does not want their child to receive a dental exam (Please see the CSN for assistance if a waiver is chosen). Forms are due no later than May 31st of the student’s first year of school (either Kindergarten or 1st). Click here for English. Click here for Spanish.


Special Meals Request: This form is used for students who have severe allergies to specific foods; and consume breakfast, lunch, or snacks provided by the school district. A medical doctor (MD), nurse practitioner (NP), physician’s assistant (PA), or other medical provider authorized to prescribe medications must complete the form on a yearly basis. The medical provider must provide the diagnosis, foods to omit, and foods to replace. Click here for English. Click here for Spanish.

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