Forms
Health Inventory Questionnaire
Certificate of Immunization Status:
Exchange of information (Seattle Children's Hospital)
Exchange of information (non-Children's Hospital)
Return to school after Concussion
Gastrostomy Tube (G-tube):
Tracheostomy Tube:
Sports Physical Forms - Please contact your school
Remember to sign and date your forms!
Annual forms/supplies for Life Threatening Conditions
Every year, we need to update your child's health plan, physician orders, and medications.
Please print out the required forms and take/send them to your doctor this spring.
The doctor's versions of these forms are acceptable, especially the School Care Plans from Children's.
Make sure doctor and parent/guardian sign the forms where applicable.
We will accept next year's forms as soon as you have them!
All required forms, medications, and supplies must be received at school’s main office no later than 1 week before the first day of school.
Failure to meet the deadline means your child will not be allowed to start on the first day of school, and will be excluded until all items are received by the school nurse.
If your child no longer has the previously identified health condition, please provide a letter from your child’s licensed health care provider stating that this condition is no longer valid for your child.
Anaphylaxis (severe allergy requiring epinephrine):
REQUIRED form: Allergy Action Plan
REQUIRED medication: Epinephrine autoinjector - unexpired
OPTIONAL: Exchange of information (see above)
Diabetes:
REQUIRED form: Current School Care Plan from Children's
REQUIRED medication: insulin, glucagon
REQUIRED supplies: see diabetes supply list
OPTIONAL: Exchange of information (see above)
Severe Seizures (requiring emergency rescue medication):
REQUIRED form:
Current School Care Plan from Children's
OR
REQUIRED medication: emergency medication (Diastat, midazolam, lorazapam)
OPTIONAL medication: 3 day supply of seizure prevention medications
OPTIONAL: Exchange of information (see above)