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Health History/Emergency Form
Please complete this form upon enrollment or if there are changes to medical information or emergency contacts.
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Medication Administration Form
Your student's clinic will need a Medication Authorization Form for each medication kept in the clinic. If the medication is a prescription a physician's signature will be required. Please make sure all medications are in their original containers and are not expired. We are unable to administer expired medications.
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Food and Environmental Allergy Form
If your child is allergic to any foods or environmental allergens please complete the following form.
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Anaphylaxis
If your child has been prescribed epinephren to treat allergic reactions, please have his/her physician complete this form and return it to the nurse with proper medication.
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Asthma Action Plan
If your child has been diagnosed with asthma or other airway diseases, please have his/her physician complete this form and return it to the school nurse.
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Seizure Action Plan
If your child has been diagnosed with any form of seizure disorder, please have his/her physician complete this form and return it to the school nurse.
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Generic Action Plan
If your child has any health condition not already listed above, please have his/her physician complete this form and return it to the school nurse.