Health Forms

MS/HS Physical Form-required for participation in both interscholastic and intramural sports in MS or HS

 

MS/HS Health History Update-Parent to fill out and hand to school nurse prior to starting new sport season

 

Elementary/Preschool Physical Form-Required for  kindergarten students and new students. Physicals recommended for grades 3 and 6.  Includes vaccine page.

 

Elementary/Preschool Parent Medical History Form-To be completed by parent and returned with physical exam to school nurse.

 

Asthma Action Plan-Medication form for asthma medications.  Parent needs to sign form also.  Parent to bring in inhaler or if nebulizer treatment ordered, medication with tubing and mouthpiece or mask.  Each school has a nebulizer.  If student is able to self medicate, please make sure physician checks form at bottom stating that.

 

Medication Form-Form to have physician fill out when student needs to have medication at school.  Parent needs to sign top of form also.  With medication form, parent must then bring in medicine in original container with pharmacy label, or if over the counter, then name written on bottle.

 

Severe Allergic Reaction Medication Form-Medication form to be used only for EpiPen or TwinJect autoinjector and/or Benedryl medication orders. Parent needs to sign bottom of form also.  Parent must bring in autoinjector and/or Benedryl medication.  If parent wants delegate for student's autoinjector, make sure physician checks that student may have delegate on order form. 

 

Vision Form-To bring to eye doctor if referred by school nurse or if going for annual checkup.