Forms

Some of these forms can be completed online, saved, and then attached to an email. Other forms must be printed then either scanned and emailed, faxed, or mailed.

Annual Student Health Information Update

Authorization for Medications Taken at School

State and federal law requires that a form must be completed and signed by both parent/guardian and a licensed health care provider with prescriptive authority for ALL medications to be given at school, including over-the-counter (OTC) medications. See Health-Related School Information for more detail. This form needs to be renewed at the beginning of each school year.

Authorization for Medications Taken at School

Students with Diabetes

Diabetes Assessment Form

Students with Seizures

Seizure Assessment Checklist

Students with Allergies

Food Allergy Assessment Form

Severe Allergy/Anaphylaxis Medication Order and Health History

Students with Asthma

Asthma Assessment Form for School

Asthma Medication Order and Health History

Authorization for Treatments and Procedures Performed at School

Gives permission for an authorized person to assist a student by performing a specific treatment or procedure.

Diet Prescription for Meals at School

Please contact your school nurse if your student has a food allergy or medical condition that requires food accommodations at school. School nurse will provide you with a prescription dietary form. Once signed and completed by parent/guardian and healthcare provider, return form to school nurse. School nurse will then provide the completed dietary prescription form to Culinary Services to process.

The form must be completed by a Licensed Physician when identifying a disability, or a Recognized Medical Authority (RMA) when identifying a non-disabling medical condition. For Diet Prescription purposes, a RMA includes a Licensed Physician, Doctor of Osteopathy, Licensed Physician’s Assistant, ARNP or Licensed Naturopathic Physician.

Extraordinary Nursing Support

Field Trip/Outdoor Education Information and Release

Field trips are an educationally sound and important component in the instructional and/or athletic programs of schools.

Your student’s teacher and school nurse will partner and communicate with you about required authorization and health forms.

Home/Hospital Instruction

Immunizations

Release of Health Care Records (Mutual Exchange)

Gives Seattle Public Schools and a health care provider, hospital, or clinic permission to exchange information about a student.

*UW/Harborview requires authorizations in English

Sexual Health Education

Transportation for Medical Reasons

For students who are within the walk zone but who have a medical condition that makes transportation necessary. May be for short-term or long-term conditions.

Application must be renewed annually.

Cannot be used to serve special education students for conditions related to their qualifying condition. Contact Special Education in those cases.