Health Forms

To help us keep your child safe and healthy at school, we require up-to-date health forms and documentation for certain medical needs. Please see the sections below to access and submit the necessary forms.

Please update the health office if your student has a new diagnosis at any time throughout the school year. 

Submit Forms to: Health Office or Front Office in person, via fax, or via email to Nurse Madison; mdelpape@sandi.net

🩺 Medication Authorization Forms

If your child needs to take medication during the school day, the following are required: 

Or see Below for Specific Emergency Medications (Asthma, Epi-Pen, Diabetes, and Seizure Action Plans)

📄 Physician's Authorization for Medication at School – must be completed/signed by both a parent/guardian and a healthcare provider.

Medications must be brought to the health office by an adult in the original pharmacy-labeled container (no baggies or unlabeled bottles).

💙 Health Plans

We provide individualized care plans for students with chronic health conditions that require emergency medications or procedures during the school day. These help staff respond appropriately in case of an emergency. 

Available plans include:

📄 Asthma Action Plan

📄 Allergy and Anaphylaxis (Epi-Pen) Emergency Action Plan

📄 Diabetes Medical Management Plan (DMMP)

📄 Seizure Action Plan

📄 Physician's Authorization for Gastrostomy Procedure

💉 Immunization Requirements

California law requires all students to be up-to-date on state-mandated immunizations before starting school. Please provide:

• Complete immunization record

• Updates as your child receives new vaccines

📄 Preschool Immunization Requirements 

📄 K-12 Immunization Requirements (PDF)
Please Note: UTK students registering for 2025-26 who are three years old at the time of enrollment must meet the preschool requirements to enroll.  Those who are four years old at the time of enrollment must meet the K-12 requirements to enroll. 

🦷 Kindergarten Dental Exam Forms

State-Mandated - Students entering TK-Kindergarten (if not previously submitted) must provide proof of a dental exam conducted within the last year - must be turned in by April of their first year.

📄 Kindergarten Oral Health Assessment Form

🩺 Kindergarten Physical Exam Forms

📄 Report of Medical Examination for School Entry

👩‍⚕️ Health Information Consent to Communicate with Physicians

To support communication between your child’s healthcare provider and the school health and education team, this form is required to authorize the sharing of relevant health information. 

📄 Authorization for Use or Disclosure of Health Information to and from Schools (HIPAA)

🍽️  Special Meal Accommodations at School

To help ensure the safety of students with food allergies or sensitivities, the cafeteria can provide meal accommodations when requested and documented by a parent (milk only) or a physician. 

📄 Parental Request for a Milk Substitution at School

📄  Medical Statement to Request Special Meals and/or Accommodations
 

🍽️  Tuberculosis (TB) Risk Assessment Questionnaire - for Volunteering at School

To volunteer at school, you must complete the Volunteer Packet with the front office and meet with Nurse Madison for an in-person Tuberculosis (TB) Risk Assessment, available on Mondays and Fridays. If you’ve recently had a TB blood or skin test from your healthcare provider, you may submit those results instead. Nurse Madison will review your risk assessment and determine if a TB test is required.