Documents

Consent to Treat

These documents must be updated each school year.  They are provided electronically as a part of the online registration process. Students must have a Consent to Treat signed by a parent or guardian to be seen in the school nurse clinic.  All students will be treated in the case of an emergency. 

• Consent to Treat
  • English Form
  • Spanish Form
• Emergency Medical Form

Community Health Network Privacy Policy

• Notice of Privacy Form

Medication Forms

Medication consent forms are necessary for any medication to be given by the school nurse during the school day.  A parent or legal guardian must complete the form for each medication.  The form will be kept on file in the school nurse clinic.  Prescription medications must be brought with the current pharmacy label attached.  The nurse must follow the instructions on the prescription label. Over the counter medications must be in the original container.  The school nurse will follow the instructions on the label unless otherwise instructed by a health care provider's written order. 

• Consent to Carry Emergency Medication
• Medication Consent
  • English Form
  • Spanish Form 

Emergency Action Plans

If you have indicated that your child has a chronic health condition on the Emergency Medical form please have your health care provider fill out one of the following forms and return to your school nurse.  These should be updated at the beginning of each school year.  

Asthma Forms

• Asthma Action Plan

Diabetes Forms

• Diabetes Action Plan

Food Allergy Forms

• Food Allergy Action Plan
• Mandatory Form for Food Allergy

Seizure Action Plan

• NEW Diastat Care plan
• Seizure Action Plan

Other Allergy Forms

• Allergy Action Plan

Immunization Information

• Religious and Medical Exemption Letter
• Religious Exemption For Immunizations
• Medical Exemption for Immunization

Lice Information and Policy

• Head lice article
• Lice Guidelines