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School Nurse

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  • ALLERGY Action Plan

    ALLERGY Action Plan

    This is used for children with allergies to foods, medications, insects etc that require prompt action and potentially the use of an automated epinephrine injector. 

    emergency-care-plan 2017 version.pdf 177.13 KB (Last Modified on June 19, 2017)
    Comments (-1)
  • ASTHMA Action Plan

    ASTHMA Action Plan

    This form MUST be completed for any student with asthma that requires the use of an inhaler and/or nebulizer.  Students are not permitted to carry inhalers without this paper work. 

    Asthma-Treatment-Plan-STUDENT-MAY-2017.pdf 1.41 MB (Last Modified on June 19, 2017)
    Comments (-1)
  • Medication Needed During School Hours Form

    Medication Needed During School Hours Form

    This form is REQUIRED to be filled out by the child's physician if medications are needed to be given during school hours.  This must also be signed by the parent/guardian.  Medications can not be given with out this form.
     
    Authorization for Medications to be Taken During School Hours 2016.pdf 24.47 KB (Last Modified on June 14, 2016)
    Comments (-1)
  • Permission for School MD to Complete Student Physical

    Permission for School MD to Complete Student Physical

    This form MUST be completed if your child requires a physical and you would like the School MD to perform the physical. 

    Consent for School MD 2021.pdf 663.27 KB (Last Modified on May 25, 2021)
    Comments (-1)
  • Personal Doctor Physical Form

    Personal Doctor Physical Form

    This can be used for any student needing a physical that is NOT RELATED to SPORTS.

    Private MD Physical 2021.pdf 494.63 KB (Last Modified on June 18, 2021)
    Comments (-1)
  • Seizure Action Plan

    Seizure Action Plan

    Complete this form if your child has seizures. This will assist in quick response customized for your child's needs. 

    SCHOOL Seizure Action Plan 2020-April7_FILLABLE.pdf 252.76 KB (Last Modified on June 18, 2021)
    Comments (-1)
  • Sports Physical Forms - New Athletes or Athletes' with Expired Physicals

    Sports Physical Forms - New Athletes or Athletes' with Expired Physicals

    COMPLETE FORMS ONLINE IF POSSIBLE - click here 

    If paper form is needed email the school nurse and she will work with you to get the forms completed.  

    Email_the_school_nurse_at_kellyn.docx.pdf 14.31 KB (Last Modified on June 18, 2021)
    Comments (-1)
  • Sports Repeater Form - Athletes with a Current Sports Physical*

    Sports Repeater Form - Athletes with a Current Sports Physical*

    Complete this form online. 

    Email_the_school_nurse_at_kellyn.docx.pdf 14.31 KB (Last Modified on June 18, 2021)
    Comments (-1)

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