School Nurse Health Services

 IMPORTANT FORMS YOU MAY NEED 

 

Asthma Management Plan Form

This form is used for students with asthma requiring care or medication in the school setting.  This is also a form for students who carry an inhaler at school.

Allergy Management Plan Form

This form is used for students with an allergy to foods or insect bites that may require care or medication in the school setting.  This is also a form for students who carry an epi-pen with them at school.

Diabetes Management Plan Form

This form is used for students with diabetes.  It allows the nurse to work with your family and your physician in caring for your insulin dependent child. 

Immunizations at School Authorization Form

This form is used for students receiving immunizations at school.  This form must be completed before any vaccinations can be administered in the school setting.

Medical Information Release Authorization Form

This form allows information to be shared with your health care provider.  This is helpful for the families of those students with chronic conditions such as asthma, diabetes, severe allergies to foods or insects so that information can be shared on an as needed basis between your school nurse and your health care provider. 

Medication at School Authorization   AND

Yearly Student Medical Update - English    Spanish Version 

These forms are updated by you each year to ensure the school nurse is aware of any medical concerns regarding your student.  These forms need to be updated whenever a chage occurs to your child's health status and at the beginning of each school year.  This form also allows the nurse to administer tylenol or ibuprofen on an as needed basis with your permission or allows you to request that you be contacted before any medications are administered to your child.

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