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Health History


The Health History Form ais a vital piece of information that communicates to the Health Office staff the medical history of the student. The form is located on the Health Services web page or through the school. Please be as specific as possible when describing a serious condition.

It is imperative that the Health office receive medical information from a Primary Care Provider if your child has a serious life threatening condition. This information will assist the Health Assistant in providing the proper care to your child during an emergency.

If your child has asthma or allergies, please be sure to indicate if the child uses an inhaler or needs an Epi Pen.  A special consent form is available if parents prefer to have their child carry an inhaler or Epi Pen in a backpack. PLEASE ENSURE THAT THE SCHOOL IS NOTIFIED.

Use the comment section to list medications taken at home or special considerations you would like the health staff to know about.

The information is kept confidential and only shared with Teachers on a need to know basis or unless otherwise directed by the parent/guardian.

The boxes in front of the over the counter medication section must be checked in order for the Nurse/Health Assistant to administer over the counter medications for minor complaints or injuries.

Please remember to sign and date the form and return it to the Health Office.

You are encouraged to alert all other school personnel (transportation, nutrition services, teachers, administration) that may have contact with your child, so they are aware of your child's condition and the treatment that may be required during school hours.


Reviewed:  12/18