This document is a student health update form for Indian Creek Schools for the 2014-2015 school year. It requests information about any medications or health conditions a student may have. These include asthma, diabetes, seizures, allergies, and any other relevant medical information. Parents are asked to provide details about their child's conditions and treatment plans. They must also sign and date the bottom of the form to acknowledge the information provided.
This document is a student health update form for Indian Creek Schools for the 2014-2015 school year. It requests information about any medications or health conditions a student may have. These include asthma, diabetes, seizures, allergies, and any other relevant medical information. Parents are asked to provide details about their child's conditions and treatment plans. They must also sign and date the bottom of the form to acknowledge the information provided.
This document is a student health update form for Indian Creek Schools for the 2014-2015 school year. It requests information about any medications or health conditions a student may have. These include asthma, diabetes, seizures, allergies, and any other relevant medical information. Parents are asked to provide details about their child's conditions and treatment plans. They must also sign and date the bottom of the form to acknowledge the information provided.
This document is a student health update form for Indian Creek Schools for the 2014-2015 school year. It requests information about any medications or health conditions a student may have. These include asthma, diabetes, seizures, allergies, and any other relevant medical information. Parents are asked to provide details about their child's conditions and treatment plans. They must also sign and date the bottom of the form to acknowledge the information provided.
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Indian Creek Schools Health Services
Student Health Update
2014-2015
Students Name: _____________________________________
Birth date: ________________
Grade: _____________
_____ My student does not have any health issues at this time. Does your child take any medication on a routine basis? YES NO During school Name of Medication ___________________________ Purpose____________________ Name of Medication____________________________Purpose____________________ Please contact the school office regarding the School Medication Policies if your child must take prescription or over the counter medications during the school day. Check the box and explain if your child has a history of, or now has the following conditions or concerns: Asthma mild moderate severe Uses inhaler at home Rescue inhaler with student Rescue inhaler in school office
Diabetes Type 1 Type 2
Seizures as infant takes medication Use emergency plan if happens at school
Allergies Bees/insects Foods ____________________ Other _____________________ EpiPen at home EpiPen at school
Other/Additional information ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Health information is shared with school staff on a need to know basis.
