Forms
*Tips for Parents from the School Health Office
***Medication in School***
If you would like your child to be given medication at school, please fill out one form per medication per child. If it is a prescribed medication, it will also require the Physician's signature. See the instructions for medications in school by clicking here.
If it is necessary for us to administer your child's daily medication OR if you would like to leave medication in the Health Office for an as needed basis, other than Tylenol or Ibuprofen, then you will need to fill out one form per child, per medication. The prescription medications will need to be signed by your ordering physician. If you have agreed to Tylenol or ibuprofen during online enrollment you will not need to complete this form.
Emergency Medication Self Carry Release Form
If it is necessary that your child carry their own emergency medication with them during school hours, such as an epi pen or inhaler, etc. then please fill out this form. One form per medication, per child. The ordering physician will also need to sign this form.
To be filled out with any new student and with any new medical update or change in student's health history.
Health Assessment Form (Physical)
To be filled out with any new student under the age of 9 and for yearly for any student participating in school sports. May use the forms from your doctor's office as well.
Care Plans
Asthma
Asthma Action Plan (To be filled out and signed by your physician)
https://www.nhlbi.nih.gov/files/docs/public/lung/asthma_actplan.pdf
Allergies/Anaphylaxis
Epi Pen Action Plan (To be filled out and signed by your physician)
Diabetes
Insulin Action Plan
http://www.choosehealth.utah.gov/documents/pdfs/school-nurses/DMMO%20emergency%20action%20plan.pdf
Diabetes Medical Management Plan
https://www.idph.state.ia.us/hcci/common/pdf/sample_diabetes.pdf