Embedded Files
English HIPAA Compliant Medical Authorization (1).rtf.pdfAuthorization for Use and/or Disclosure of Information
Authorization for Use and/or Disclosure of Information
Allows the school district to receive and/or release information to a provider to discuss students current physical, mental and/or behavioral health .
HJUHSD Special Food Meal accomodation.pdfMedical Statement to Request Special Meals and/or Accommodations
Medical Statement to Request Special Meals and/or Accommodations
This form should be completed if your student has a medical condition or disability that requires a special meal and/or accommodation OR has a food intolerance or other medical reason.
*Food preferences are not an adequate use for this form.
Allergic REaction parent questionnaire
Allergic REaction parent questionnaire
This form should be completed if your student has a diagnosed allergy from a medical provider. This information will be used to help our health services staff better serve your student at school.
*Food preferences are not an adequate use for this form.
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