Embedded Files
General Medical Forms
General Medical Forms
District Medical Handbook
District Medical Handbook
This Handbook will answer frequently asked questions regarding District medical procedures including: Absences, Communicable Diseases, School Attendance, Health Screenings, Immunization Requirements, Injuries, Long Term Illness or Injury, Medication Use in School, Pediculosis Guidelines, Physical Education Excuses, and History and Physical Examinations.
History & Physical Examination Form (Grades K- 5)
History & Physical Examination Form (Grades K- 5)
This physical examination form is used for students in grades K-5.
History & Physical Examination Form (Grades 6 - 12)
History & Physical Examination Form (Grades 6 - 12)
This physical examination form is used for students in grades 6 - 12 as well as for Athletic Pre-Participation. This form will be the only form accepted if the student participates in any athletic program in our district.
Student Medical & Health History
Student Medical & Health History
These health history forms allow for parents/guardians to communicate pertinent health information and history to the school, including regarding historical conditions for which students have received treatment or intervention
Medication Authorization
Medication Authorization
If your child requires prescription or over-the-counter medication during the course of the school day, this form must be completed by your physician and signed by the parent/guardian. Medications must be provided in the original pharmacy packaging.
Health History Update for Athletic Programs, Intramural Programs and Club Sports
Health History Update for Athletic Programs, Intramural Programs and Club Sports
Each student whose medical examination was completed more than 60 days prior to the first practice session must provide a health history update of any medical problems experienced since the last medical examination.
Allergies
Allergies
Allergy Food Action Plan for Severe Food Allergies
Allergy Food Action Plan for Severe Food Allergies
This form must be completed and signed by the physician and parent/guardian if your child is required to use Epinephrine (Epi Pen) and/or any other medication for severe allergic reactions to food.
Allergy Plan for Severe Reactions to Non-Food Substances
Allergy Plan for Severe Reactions to Non-Food Substances
This form must be completed and signed by the physician and parent/guardian if your child is required to Epinephrine (EpiPen) and/or any other medication for severe allergic reactions to insect bites, latex, or any substances other than foods.
Parent Epinephrine Delegation
Parent Epinephrine Delegation
This form allows parents to authorize delegates who have been trained to administer life saving Epinephrine in the case of a potential life threatening allergic reaction.
Food Allergy Letter for Lunch Seating
Food Allergy Letter for Lunch Seating
This form must be completed and signed by a parent/guardian if your child has food allergies in the elementary schools.
Allergies
Allergies
Asthma Action Plan
Asthma Action Plan
This form must be completed and signed by the physician and parent or guardian if your child requires an inhaler or nebulizer while in school.
Diabetes
Diabetes
Diabetes Medical Management Plan
Diabetes Medical Management Plan
This form must be completed and signed by the physician and parent or guardian if your child has been diagnosed with diabetes and requires management of blood glucose levels during the school day (including use of continuous glucose monitoring devices and insulin pumps).
Parent Glucagon Delegation
Parent Glucagon Delegation
This form allows parents to authorize delegates who have been trained to administer life saving Glucagon in the case of potentially life-threatening hypoglycemia.
Seizures
Seizures
Seizure Action Plan
Seizure Action Plan
This form must be completed and signed by the physician and parent or guardian if your child has been diagnosed with Epilepsy and/or a convulsive disorder.
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