Health Office / Forms

District Health Forms

Medication Forms

	Asthma Asthma Health History Information Asthma Treatment Plan
	Food Allergies Allergic Reaction Medication Form
	Other Medications Acetominophen(Tylenol)/Ibuprofen Permission Medication Form (Daily & PRN)
	Procedures Procedure Authorization Form

Other Forms

	Immunization Flu/Influenza Vaccine Form, Preschool Meningococcal-Tdap Vaccine, gr 6 NJ Immunization Information Registry Memo & Permission Form (English) NJ Immunization Information (NJIIS) Registry Memo and Permission Form (Espanol) Spanish Memo & Spanish Form
	Sports (JP Case) Athletic Forms, Part A and B -Health History Questionnaire and Physical Evaluation form (7 pages) Concussion letter

Miscellaneous Forms

Physical Exam Form, Grades PreK-4, required for school entry; to be completed by your health care provider.

Student Health History, required for school entry; to be completed by parent

Health History Update, English, required annually; to be completed by parent

Historia Clinica/Student Health History Update (Espanol)

Dental Evaluation Form - Required for all entering kindergarten and grade 1 students and recommended for grade 5 (English)

Examen Dental -Todos los niños que se inscriben en el Kindergarten y primer grado deben presentar un examen dental, es recomendable dicho examen para todos los niños hasta el quinto grado. (Espanol)

Seizure Questionnaire - completed by parent

Seizure Action Plan - completed by healthcare provider

Last Modified on March 6, 2013