Health Services

RSD Health Forms

Administration of Oral Medication

Authorization for Administration of Oral Medication (Form 3649- PDF 45K)

Immunization Forms

• 2009-2010 Immunization requirements for new enrollees
• Certificate of Immunization Status form - English
• Certificate of Immunization Status form - Spanish

Certificate of Immunization Status Forms are also available in the following languages. Please download or contact your school's nurse to obtain a copy.

Certificate of Exemption

Allergies

• Parent instruction form for serious allergies
• Life Threatening Health Condition Letter
• Allergy Information Form
• Allergy Action Plan
• Health Care Provider Instruction Letter
• Authorization for Release of Medical Information

Asthma

• Life Threatening Health Condition Letter
• Asthma Individual Health Plan
• Authorization for Release of Medical Information
• Authorization for Administration of Oral Medication

Seizure

• Parent Instruction form for seizures
• Life Threatening Health Condition Letter
• Seizure Disorder Information
• Seizure Action Plan - Elementary
• Seizure Action Plan - Secondary
• Authorization for Release of Medical Information
• Authorization for Administration of Oral Medication

Diabetes

• Life Threatening Health Condition Letter
• Diabetes Individual Health Plan
• Diabetes Emergency Care Plan
• Health Care Provider Orders for Students with Diabetes
• Health Care Provider Orders for Students wearing an Insulin Pump
• Diabetes Emergency Supplies
• Authorization for Release of Medical Information
• Authorization for Insulin Pump Usage at School