FORMS & RELATED INFORMATION

POTASSIUM IODIDE CONSENT FORM_19_20.docx
2023_MAPLE LAKE OVER THE COUNTER MEDICATION FORM.doc
2023_MAPLE LAKE OVER THE COUNTER MEDICATION FORM.doc
2023 MAPLE LAKE PHYSICIAN APPROVAL MEDICATION FORM.doc
2023_MAPLE LAKE SELF ADMINISTRATION MEDICATION FORM.doc

MEDICATIONS:

Completed FORMS are required for any student that requires PRESCRIPTION or OVER-the-COUNTER medication during the school day.  All medications must be brought to school in their original container to the health office. High school students may carry over-the counter medications if a SELF ADMINISTRATION FORM is completed and signed by the student, parent and school nurse. 

IMMUNIZATIONS:

The state issued a new form to record immunizations in April 2019. 

REQUIREMENTS for STUDENTS GOING INTO 12TH GRADE:

This is a reminder that students that are moving into 12th grade next year have a NEW State immunization enforced requirement. Teenagers and young adults are at higher risk for meningococcal disease. This dose is important to make sure they are fully protected through their highest-risk years.

7TH GRADE immunizations:

The Minnesota Law requires that 7th grade students have the immunizations against these serious diseases updated before starting school.  The school will need the date that these immunizations were given. You can do this by sending in a copy from your clinic record or by calling the school health office.        

KINDERGARTEN Required Immunizations:

·        Diphtheria-Tetanus-Pertussis (DtaP): 5 doses (5th dose not required if 4th dose was given after 4th birthday)

·        Polio:  4 doses (4th dose not required if 3rd dose was given after 4th birthday)

·       Measles-Mumps-Rubella (MMR): 2 doses

·       Hepatitis B: 3 doses

·        Varicella/chicken pox:  2 doses OR date of disease (month/year) of disease 


SPECIAL DIET:

If your child requires a special diet while at school, we must have the SPECIAL DIET FORM completed.  It must be signed by the parent and a licensed physician, physician assistant or advanced practice nurse practitioner. 

POTASSIUM IODIDE (KI)

The paper consent form and information sheet are attached.  This will only be administered with parent permission and at the direction of Homeland Security in the unlikely event of a nuclear accident.