Health Forms

NEW STUDENT FORM 

Physical Exam Form for grades Pre-K through 5 (To be completed by healthcare provider upon admission to the district)

MEDICATION ADMINISTRATION FORMS

PLEASE NOTE THAT ALL MEDICATION FORMS NEED TO BE COMPLETED BY THE HEALTHCARE PROVIDER AND SUBMITTED ANNUALLY IN SEPTEMBER

Healthcare Provider includes: MD, DO, APN(NP), PA

Asthma Medication

• Asthma Action Plan (To be completed by healthcare provider and parent) 

Medications for Allergic Reaction/Anaphylaxis

• Epi Administration Permission Form (To be completed by parent) 
• Food Allergy and Anaphylaxis Emergency Care Plan (To be completed by healthcare provider and parent)

Type 1 Diabetes  

• Diabetic Action Plan (Diabetic plan from Endocrinologist is also acceptable) 

Seizures

• Seizure Action Plan (Seizure Action Plan from Neurologist is also acceptable)
• Medication Permission Form (To be completed by healthcare provider and parent if daily seizure medications are required to be taken during school hours)

All Other Medications Including ADHD, Adrenal Insufficiency, and OTC Meds, etc

• Medication Permission Form (To be completed by healthcare provider and parent)