Health Forms

  • Medication Assistance - Request Medication Assistance Form
    Students will be assisted with their medications by the School Health Specialist or personnel designated by the building administrator. A “Medication Assistance Form” must be filled out and on file in the clinic for a student to receive any medication at school (including over-the-counter medication such as cough drops, Motrin, etc.) For specific requirements, review both sides of the Medication Assistance Form available by clicking on the hyperlink above, in the school clinic or in the school office.

    Immunizations & Physical Examination Form - Immunizations & Physical Exam
    Immunizations (Must be excluded from school if information not provided or student not up-to-date)
    Ohio law mandates that pupils enrolled in kindergarten through grade 12 have written proof on file, at their school, that they have received minimum vaccines for: Diphtheria, Tetanus, Pertussis, Hepatitis, Poliomyelitis, Measles, Mumps and Rubella. Students kindergarten through first grade are required to have proof of the Varicella vaccination or Chickenpox disease. Pupils who are not in compliance are to be excluded from school attendance.

    Diabetic Orders - Healthcare Provider Orders for Student with Diabetes Form
    All students with diabetes will need orders from their physician in order to be tested and treated while in school. Orders are needed on all diabetic whether independent in their testing/ treating or not, due to the fact they may be incapacitated and require the assistance of the School Health Specialist. If no orders are on file in the clinic EMS will be called. Additionally all diabetic should keep a rescue kit of snacks, juice, gel or glucose tabs in the clinic in the event of a hypoglycemic event. Please click on the hyperlink about to obtain your diabetic order form.

    History & Physical Examination
    A physical examination is required for preschool (recommended for kindergarten) - due on admission to program and annually from date of examination.

Last Modified on December 11, 2018