District U-46 Health Forms

Dental Forms

• Proof of Dental Exam
• Dental Exam Waiver

Physical Form

• Physical Form - English
• Physical Form - Spanish

Eye Exam Form

• Eye Exam Form

Medication Forms
District policy mandates that signed permission forms must be on file before medication can be dispensed to a student or carried by a student. This form may be presented at registration or sent directly to the school nurse before the first day of school.  The top part of the form is filled out by the parent and the bottom half is filled out by the physician.

• Medication Permission Form (Doctor's order form) - English
• Medication Permission Form - Spanish
  Additional medication forms
• Self-Administered Medication Permission Form
• Self-Administered Medication Permission Form - Spanish
• Medication given to Bus Driver

Allergy Forms

• Allergy Assessment Form
• Bee Sting Form - English
• Bee Sting Form - Spanish

Asthma Forms

• Annual Asthma Assessment
• Asthma Action Plan
• Asthma medication permission and physician instruction - English
• Asthma medication permission and physician instruction - Spanish