Health Information




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School Nurse's Immunization Letter
The school nurse details the immunization requirements

Medical Examination and Immunization Record
Use this form for the medical examination of student by a private physician and for immunization information.

School Nurse's Medication Letter
The school nurse details the administration of prescription and/or over-the-counter medications.

Parental Permission for First Aid, Screenings, Medications and Release of Medical Information
Use this form to give the school nurse permission to administer medication.

Helpful Information on Food Allergies
Use this form to help the office and your child's teacher better understand your child’s food allergies and what precautions and treatments should be followed

Emergency Health Plan for Anaphylaxis
Use this form to authorize permission for emergency treatment due to allergies.

School's Policy on Epinephrine Administration
Use this form to be informed of the school's policy on epinephrine administration.

Self-Administration of Medication
Use this form to authorize your child to self-administer his/her medication.

Diocesan Waiver/Consent Form to Designate the School Nurse to Administer Medications
Use this form to designate the school nurse (or Designee(s)) to administer medication.

School Nurse's Asthma Letter
The school nurse provides information on the Asthma Action Plan.

Asthma Action Plan
Complete this form if your child has any type of Asthma or Reactive Airway Disease.

Emergency Information
Use this form for emergency contact information.

Important Information Regarding Physical Exams for Students Participating in Sports or Cheerleading

Annual Athletic Pre-Participation Physical Examination Form
Use this form for the medical examination of student by a private physician prior to participating in any ATHLETIC event

Health History Form
Checklist of medical concerns - form must be in on the 1st day of school

Helpful Information Concerning Your Child’s Insect or Bee Sting Allergy
Use this form to help the office and your child's teacher better understand what precautions and treatments may be necessary if your child has a reaction

Authorization to Administer Over-the-Counter Medications
Use this form to give the school nurse permission to administer a throat soother or Tums.

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