**EVERY STUDENT WITH A NEW HEALTH CONCERN NEEDS A STUDENT HEALTH EVALUATION INTAKE FORM**
- Health forms must be submitted every twelve months.
- Please print your paperwork, fill out completely, and bring the completed and signed paperwork to the Health Aide at your student’s school.
- All health forms require a parent signature, most forms require a Provider’s signature as well.
- Medication must be delivered by the student’s guardian and checked in with authorized staff.
- Medication delivered by a student will not be accepted.
- Each medication must have a pharmacy label.
- Every student with a medical concern must have a bus form for field trips.
In the case of a concussion/head jury/TBI, please call the nurse at (435)-395-8219
The following forms are ALL required:
- Diabetes Emergency Action Plan
- Diabetes Individual Health Care Plan
- Diabetes Bus Form
- Diabetes Medication Management Order
- Daily Medication Administration
- Insulin Injection Form
If the student uses a CGM, this form is required:
If the student uses a PUMP, this form is required:
ALL below forms required:
The following forms are required for students with medications at school:
The following forms will be given to need-to-know staff:
If none of the standardized forms apply to your student, you can utilize the following forms:
- Student Health Evaluation Intake Form
- Student Health Evaluation Intake Form – Spanish
- Release of Information Authorization
- Release of Information Authorization – Spanish
- Medical Statement to Request Special Meals, Accommodations, and Milk Substitution
- Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions Spanish
- Generic Bus Form