Health Services

RSD Health Forms

Administration of Oral Medication

• Authorization for Administration of Oral Medication (Form 3649)

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

Diabetes

• Diabetes Emergency Care Plan
• Diabetes Emergency Supplies
• Diabetes Healthcare Provider Orders
• Diabetes Individual Healthcare Plan

• Diabetes Insulin Pump Orders

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

Immunization Forms 

• Certificate of Immunization Status form - English
• Certificate of Immunization Status form - Spanish
• Certificate of Exemption (NEW 2011)
• Certificate of Exemption 2011 in Spanish

Certificate of Immunization Status (CIS) Forms are available in the multiple languages. Please download a blank copy if needed.

Certificate of Immunization Status forms in multiple languages