Forms, Care Plans, and Permits
The following forms are available for you to print and complete. In addition to parent input, some of the individual health care plans require completion by, and a signature from, a physician.
Contact your school nurse if you have questions or concerns. Return the completed care plans to your school nurse as soon as possible.
The parent is responsible for informing the school of medical care that is needed and for completing the care plans.
Licensed health care providers' orders are required for specialized health services such as Epi-pen injection, self administration of medications during school, blood glucose monitoring (insulin administration), gastrostomy tube feedings, clean intermittent catherizations, nebulizer treatments, food allergies, etc.
Forms Available in English
- Allergic Reaction Emergency Health Care Plan
- Asthma Care Plan
- Administration of Medication at School, Authorization
- Administration of Medication at School, Procedure
- Administration of Herbal Suppliments at School, Authorization
- Authorization to Provide Diabetes Care Including Glucagon Injection by Trained Non-medical School Personnel
- Consent to Release Medical Information
- Diabetes Medical Management Plan
- Diabetes Medical Management Plan, Insulin Pump Supplement
- Diabetes Supply List Needed for School
- Dietary Needs in Child Nutrition Programs - Physician Statement
- Food ALLERGY/Intolerance Prescription
- Food Allergy Individual Health Plan
- Health History
- Hemophilia IHP
- Notice of Immunization for all Students Enrolling in School
- School Dental Examination
- Self-Carry Medication
- Seizure IHP Care Plan
- Shunt Care Plan
- 'Sports Physical' - Preparticipation Physical Evaluation
- Kindergarten Physical Form
- CDC website
- A Fact Sheet for Athletes
- A Fact Sheet for Parents
- Concussion Acknowledgement and Signature Form for Parents and Student Athletes
Forms Available in Spanish
- Aviso de vacunación para todos los estudiantes que vayan a matricularse en la escuela
- Consentimiento para la liberación de información médica
- Examen dental de la escuela
- Expediente físico y de salud del estudiante
- Historial de Salud
- Registro de vacunación
- Suministro de medicación en la escuela (Guía para los padres)