Health Forms

Health Forms: New forms are required for each school year or when a medical condition changes

Authorization for medication administration:

This form is required for any medication, over-the-counter or prescription.

A physician must sign this form and must renew it each school year.

• Medication Authorization General - EN
• Medication Authorization General - SP

Forms for Asthma

• Medication Authorization Asthma - EN
• Medication Authorization Asthma - SP

Forms for Anaphylaxis

• Medication Authorization Anaphylaxis - EN
• Medication Authorization Anaphylaxis - SP

Diabetes medical management plan:

Regardless of a student's level of independence in managing their diabetes, written orders must be on file in the health office to be prepared for any emergency. These orders should also include an order for Glucagon.

Release of Health Information:

This form is required for school staff to contact the physician for various reasons. Some reasons include correcting errors in the physician's orders promptly and discussing unclear procedures in the physician's orders. This form is particularly helpful for nurses when parents have difficulty reaching their child's healthcare provider.

• Authorization for release of health information

Communicable Diseases

• Respiratory Viruses (COVID-19, Flu, and RSV, )
• Preventing the Spread of Respiratory Viruses when you're sick
• Preventing the spread of Respiratory Viruses when you're sick (Spanish)

Information regarding California health care for all children:

• Covered California