Health Related Forms

Authorization to Administer Prescribed Medication

Any student who must take medication (including over the counter) must submit this form signed by a physician and parent/guardian.

Health History & Physical Examination

This is required for all first grade students.

Sports Physical Form

This form is required for participation in all team sports.

3 Day Disaster Supply of Medication Form

Rev 3.16.11

Severe Allergy Health Care Plan

If your child suffers from allergies where an Epi-pen has been prescribed please complete this form and bring it to your child's school office.

Oral Health Parent Letter

Parent information regarding mandatory Kindergarten dental screening.

Oral Health Assessment/Waiver Request Form

Parents of Kindergarten students please bring this form to registration.

Vision Report

If you have received notification that your student did not pass the vision screening the optometrist needs to fill this form out and return to district nurses.

Health and Development Letter

If your student needs Special Education services this letter describes the health and development form.

Health and Development Form

This 10 page document is filled out prior to providing special needs for your student.

Seizure Action Plan

If your student has been diagnosed with a seizure disorder please return this form to the school office.

Seizure Identification Worksheet

To better recognize and treat our students with a known seizure disorder, it is required that the parents fill out the Seizure Action Plan along with the Seizure Identification Worksheet.

Authorization for Use and/or Disclosure of Health Information

To insure confidentiality please sign this form in order for designated school personnel to contact your health care provider.

Asthma Action Plan

If your student has been diagnosed with asthma and/or needs permission to carry an inhaler please review this form. This form requires physician authorization and parent/guardian signature.

Concussion Information for Athletes Grades 7-12

Information on concussion management for student athletes grades 7-12.

Concussion Notification to Doctor

Letter to notify a physician that a student athlete may have suffered a concussion during a team event.

Concussion Management - Physical Restrictions Form

A form to be completed by a physician outlining the physical restrictions on a student who has had a concussion.

Concussion Clearance Form

Form letter to be completed by a physician that allows a student athlete to return to team sport activities.

Diabetes Management

When your student is diagnosed with diabetes please fill out the forms and contact the district nurses.

Healthy Family Application

The Healthy Family program is a free or low-cost health insurance program for eligible California residents.

Healthy Family Application (Spanish)

The Healthy Family program is a free or low-cost health insurance program for eligible California residents.

Healthy Family Website

The Healthapp web site is the State of California's online application for the Healthy Families Program.