Health Services Forms
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Electronic Immunization Form |
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Formulario Para Dar Permiso De Administrar Medicamentos |
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Health History and Physical Assessment Questionaire (Kdg/new to district K-5) |
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Cuestionario del Historial de Salud y Evaluación Física (Kinder/nuevo al distrito K-5) |
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Health Questionaire (yearly update grades 1-12) |
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Actualización del Cuestionario de Salud (Grados 1º-12º) |
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Medication Permission Form |
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Release of Confidential Information |
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Secondary, Long Health Questionaire (new to district Grades 6-12) |
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Cuestionario de Salud para los estudiantes nuevos en el Distrito (Grados 6º-12º) |
Health Care Plans & Related Forms (Only as needed or requested) |
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A health plan is a plan developed by the school nurse with the assistance of the parent for the management of a student's health concern at school. The following plans are available as fill-in-the-blank forms and can be filled in by the parent, SIGNED, and returned to the school health office for use. The school nurse will contact you if further information or clarification is needed. Other health conditions also have plans but must be written on an individual basis. Please contact the school nurse. Some medications can be carried by and self-administered by students who are able to manage their condition and medications independently. Contracts are available below if this is an option. |
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Allergy-Anaphylaxis Plan Form |
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Allergy Informational Letter Primary Grades |
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Carta Informativa de Alergias para Grados Primarios |
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Allergy Informational Letter Secondary Grades |
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Carta Informativa de Alergias para Grados Secundarios |
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Allergy-EPI-Pen Contract |
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Contrato Para Estudiantes Que Traen Inyecciones de Epinefrina (EPI-Pen) A La Escuela |
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Asthma Informational Letter Primary Grades |
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Carta Informativa de Asma para Grados Primarios |
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Asthma Informational Letter Secondary Grades |
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Carta Informativa de Asma para Grados Secundarios |
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Asthma Emergency Plan |
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Health Questionaire for a Student with Asthma or Breathing Problems |
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Plan de Cuidado Para Un Estudiante Con Asma O Problemas Respiratorios |
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Asthma Contract |
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Diabetes Contract (Secondary Grades) |
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Contrato de Diabetes |
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Diabetes Provider Orders |
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Seizure Disorder Plan |
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Student Emergency Plan |
School Physicals |
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School health services are meant to augment, not replace annual health care supervision by your child's primary health care provider. Therefore, the district requests that students entering kindergarten, fourth, seventh, and tenth grades have a physical examination. The examination should be performed by the student's family physician and at no cost to the school district. A special form is available from your school, the Administration Building, at most local doctors' offices, or you can get the school physical form below. |
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School Physical Form |
