Health Services Forms

Health History/Emergency Form

Please complete this form upon enrollment or if there are changes to medical information or emergency contacts. 

Medication Administration Form

Your student's clinic will need a Medication Authorization Form for each medication kept in the clinic. If the medication is a prescription a physician's signature will be required.  Please make sure all medications are in their original containers and are not expired.  We are unable to administer expired medications.

Food and Environmental Allergy Form

If your child is allergic to any foods or environmental allergens please complete the following form. 

Anaphylaxis

If your child has been prescribed epinephren to treat allergic reactions, please have his/her physician complete this form and return it to the nurse with proper medication.

Asthma Action Plan

If your child has been diagnosed with asthma or other airway diseases, please have his/her physician complete this form and return it to the school nurse.

Seizure Action Plan

If your child has been diagnosed with any form of seizure disorder, please have his/her physician complete this form and return it to the school nurse.

Generic Action Plan

If your child has any health condition not already listed above, please have his/her physician complete this form and return it to the school nurse.