FORMS

Below are the most commonly requested health forms that your student may need during the school year. If you need a form that is not listed below, contact the school nurse for your student's building.

School Physical Form

Religious Waiver Form

Inhaler Release Form

School Physical Form - Spanish

Dental Exam Form

Medication Form

Inhaler Self Carry Form

EpiPen Self Carry Form

Vision Exam Form

Food Substitution Form

EpiPen Release Form

CARE PLANS

Below you will find care plans for students with chronic illnesses. Please have your student's physician fill out the appropriate care plan and submit to the school nurse at the beginning of each school year.

Asthma Care Plan

Diabetes Care Plan

Seizure Care Plan

Food Allergy Care Plan

SPECIAL HEALTH FORMS

Below you will find forms for any special health procedures that your student may need while at school. Please have your student's physician complete and sign the form and then submit to the school nurse prior to the start of school.

G Tube Order Form

Oral Suctioning Order Form

Oxygen Therapy Order Form

CLINTON CUSD 15

HEALTH SERVICES

FORMS

CARE PLANS

SPECIAL HEALTH FORMS