Medical Forms Regarding Your Child's Health

School Vaccination Requirements

• For attendance in all grades of Pennsylvania school districts, students must have the vaccinations listed on this form.

Immunization Exemption Form

• This form may be used for the exemption from required immunizations for medical or religious beliefs.

Health History Form

• This form is used to inform the school nurse of any health problems that could affect your child during the school day. Providing current and important health information will enable the school nurse to provide the best care to your child during the school year.

Private Physician Physical Form

• According to PA School Code, a physical exam is required for all students enrolled in K or 1, 6 & 11 grades. The exam can be done at school by the school physician free of charge or by your private physician at your own expense. Please have your private physician complete this form if you choose not to have a school physical exam for your child.

Physical Consent Form

• This form should be printed and completed by identifying if your child will have a private or school physical exam. Please include the physician's name and the date of appointment if choosing to have a private exam. This consent must be signed by the parent/guardian in order for your student to have the exam performed at school, free of charge.

Private Dentist Examination Form

• According to PA School Code, a dental exam is required for all students enrolled in K or 1, 3 & 7 grades. The exam can be done at school free of charge by the school dentist or by your private dentist at your own expense. Please have your private dentist complete this form if you choose not to have a school dental exam for your child.

Dental Consent Form

• This form should be printed and completed by identifying if your child will have a private or school dental exam. Please include the dentist's name and the date of appointment if choosing to have a private exam. This consent must be signed by the parent/guardian in order for your student to have the exam performed at school, free of charge.

Prescription Medication Parent/Physician Consent Form

• This form must be completed to store, dispense, supervise or administer any medication during school hours. Physician and parent/guardian signatures are required for all prescription medication. For non-prescription medication only parent/guardian signature is required.

Over The Counter Medication Consent Form

• This form must be completed by the parent/guardian in order for the school nurse to administer stock over the counter medications to your student on an as needed basis.

Asthma Individualized Health Plan

• Communicate with your school nurse the treatment necessary to for good management of your child's asthma and what to do if he/she has an asthma attack at school.

Diabetic Individualized Health Plan

• Communicate with your school nurse the treatment necessary for good management of the diabetic student and what to do if they have problems with their diabetes at school.

Seizure Individualized Health Plan

• Communicate with your school nurse the treatment necessary for your child with a seizure disorder and what to do if your child has a seizure at school.

Severe Allergies (Anaphylaxis) Individual Health Plan

• Communicate with your school nurse, the treatment necessary for your child with a serious bee, food, or other allergy in the case of an exposure or reaction at school.