Health Forms

Updated July 18, 2017

Health Forms and Documents

Procedures

Health Conditions

Parents: If you indicated on the Emergency Medical Form that your child has a health condition, please complete all applicable health and medication forms, and return them to the school nurse. This information and medication authorization is mandatory for students who need medication at CJ.

All students with health conditions need the Authorization for Self-Carry Administration of Medication Form and Authorization for School Personnel Administration of Medication Form (both listed above) completed as well as the following form(s) coinciding with the student's condition:

ASTHMA

  • Complete and submit asthma form
  • Obtain medical authorization for the applicable medication form(s) to both self-carry and self-administer an inhaler, or to have an inhaler available in the clinic for use, or both. Medication must be labeled and dispensed in the original container.

DIABETES

FOOD ALLERGIES OR BEE STING ALLERGIES

  • Complete and submit the Food Allergy Action Plan Form
  • If your student has an allergy to bee stings, complete and submit the Food Allergy Action Plan Form, but cross out food allergy, and write in “BEE STING.”
  • Obtain medical authorization for the applicable medication form(s) to both self-carry and self-administer an EpiPen, or to have an EpiPen available in the clinic for use, or both. Medication must be labeled and dispensed in the original container.

SEIZURE DISORDER

Formularios de Salud en Español