Health Forms

 

Here are health forms to print as needed, fill out and bring to school. Many need to be filled out and signed by your health care provider. There is also a guide for parents on childhood illnesses, from the Iowa Dept. of Public Health.

If you have trouble accessing any of these Google Docs, please contact the webmaster@n-winn.k12.ia.us.

1. Registration Health Form.(Google document) Annual student health information and permission (Word document): With this form, you can give the school nurse or trained office staff permission to give your child over-the-counter medicine as needed and weekly fluoride mouth rinse. It also gives us updates on your child’s health including allergies, physical, dental and eye exams. This form may be submitted separately from the front page of the Student Health and Cumulative Record.

2. Health History and Exam (PDF): Use this form when your child first starts school, typically Pre-School or Kindergarten. If you do not have health insurance that covers your child’s physicals, dental or vision, contact hawk-i (Healthy and Well Kids in Iowa)

· (800) 257-8563

· apply online at hawk-i.org

3. Dental Screening Form. (Google document) All students entering Kindergarten need to have a dental screening with this form. Screening can be done by a dentist, a dental hygienist or a licensed health care provider. We strongly recommend that all children have an exam by a dentist twice a year or as recommended by your dentist. If you don’t have a family dentist or aren’t able to pay for a check-up, call (800) 862-6133 and ask for the I-Smile dental program.

4. Vision Screening form. All students entering Kindergarten and Third Grade need to have a vision screening recorded on this form.

5. Athletic Physical (pdf): North Winn students in grades 6, 7 and 8 who will play sports at school must have a sports physical for the current year. Clinics offer sports physicals at reduced fees.

If you do not have health insurance that covers your child’s physicals, dental or vision, contact hawk-i (Healthy and Well Kids in Iowa)

· (800) 257-8563

· apply online

Medication administration:

6a. Long-term or daily medicine 2016-17 (PDF): Complete the top part of this form for medicine or a health treatment that will be given to your child at school for longer than one month. Medication must be brought to school in the original pharmacy container.

6b. Two times per day medicine form 2016-17.(PDF)

7. Short-term medication administration (Google document): Complete the top part of this form for medicine or a health treatment that will be given at school for one month or less, such as an antibiotic. Medication must be brought to school in the original pharmacy container.

8. Self-administration of medicine (Google document): You and your child’s doctor fill out this form if your child will be responsible for carrying and using medicine, such as an inhaler.

Special Health Needs:

9. Asthma Action Plan (pdf): Complete this form so that school staff know how you and your doctor manage your child’s asthma. If school staff will help give asthma medicine, also complete the medication administration form. If your child will carry his/her own inhaler, complete the self-administration form.

10. Food Allergy Action Plan (pdf): If your child has a life-threatening food allergy, complete this form.

General Information:

11. Guide to Childhood Illnesses: A helpful list from the Iowa Dept. of Public Health with illnesses, symptoms, and advice on when to keep your child home from school or go to the doctor.