Health Room Forms

PA Dental Form(pdf)

PA Physical Exam Form(pdf)

Asthma Action Plan (pdf) This is for the parents/guardians of any student that has an inhaler in school. It includes triggers that your child may have as well as personal peak flow. Please fill out the Emergency Information and have your physician complete the remaining information.

Request for Giving Medicine (pdf) Prescription medicine needs to be in the original container, labeled with your child's name. Please have inhalers in the original box labeled with your child's name. Over-the-counter medications must be in the original container, accompanied by a parent/guardian note with the name of the medication, dosage, and the time medicine is to be given. This includes cough drops and throat lozenges.

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