Forms and Documents

Immunization Records/Exemption:

• Student Immunization Record/Exemption form 

Medication Forms:

• Medication Authorization Form

  • Must be in compliance with MN Statute 121A.222. No medication is administered by the health office without specific written instructions from a medical provider. This includes all over the counter (OTC) medication except as noted below. 

• Self Carry Authorization Form

  • Note: This form is for HIGH SCHOOL students only

  • Must be in compliance with MN Statute 121A.222, for a student to carry/self medicate with OTC medications like Tylenol, Advil etc. No combination medications or medications containing Pseudoephedrine may be carried by the student.  

NOTE:  If your child is prescribed narcotics, the school recommends keeping the child home until over the counter pain medication is sufficient to manage their pain. 

Health Care Plans/Action Plans:

• Allergy/Anaphylaxis Action Plan

• Asthma Action Plan

• Diabetes Action Plan

• Seizure Action Plan

Authorizations/Releases/Consent forms:

• Treatment Authorization 

  • For any non-medication related medical need your student may have (requires medical provider signature). 

• Altered School Day Permissions

  • Instructions for your student's medications and treatments on late start, early out, or field trip days. 

• Remoted Diabetes Monitoring Agreement

  • Parental consent and agreement for the school district to have access to a student's CGM remote monitoring device.

• Release of Information (ROI) Authorization

  • Contact the office to complete this form.

Special Diet Requests

•  Special Diet Statement 

  • Form to request a special diet for a participant with a special diet need (completed by health care provider).

  • Parents may provide a written request for lactose-reduced milk if their child is lactose intolerant without a medical provider's signature. 

Health/Physical Exams:

• Early Childhood Screening 

• Health Questionnaire for new students and students with a change in medical condition

• Kindergarten Health and Dental Evaluation (completed by health care provider)

• Sports Qualifying Physical  (completed by health care provider)