School Health Services

Documents

• Supplemental Health Services - Sydney Hahn, APRN
  • Staff Consent Form
  • Make an Appointment
• Application for Home/Hospital Instruction
• Student Illness Policy
• Diet Modification Form
  • Meal Modification Form
    If your child requires a modified meal that may include exclusions or substitutions of certain foods or specialized meals that are medically documented, please complete this form to ensure we provide safe meals for your child during school hours.
• Care Plans
  • Seizure care plan
    Must be completed for all types of seizures with and without emergency and maintenance medication
  • Anaphylaxis Care Plan
    Must be completed for anaphylactic allergies, Epi Pen and any other related medications
  • Asthma Care Plan
    Must be completed for asthma, rescue inhaler and any other related medications
• Medication Administration
  • Authorization to Administer Medication
    Must be completed for all over the counter and prescription medications not covered by a specific care plan. Medications may not be given at school without a completed form. 
  • Overnight or Extended Day Field Trip Medication Authorization Form
    Must be completed for any medication that will need to be given during an extended day or overnight field trip
  • Medication Distribution Policy
• School Health Forms
  • Kentucky Immunization Registry (KYIR) School Permission Slip
    “Kentucky has a statewide immunization registry (KYIR) that medical practices use to help keep track of their patient’s immunizations. The information in KYIR is CONFIDENTIAL- only authorized users may access the system. Please complete this form if you agree to grant permission for your child’s school to provide your child’s immunization history to KYIR. By completing this form, you can make your child’s immunization history more complete, helping to ensure appropriate and timely future immunization.
  • Consent to Release and Exchange Information
  • School physical form
    Must be completed for Kindergarten entry, 6th grade entry and initial entry to Kentucky public schools
  • Eye Exam Form
    Eye exam form for school entry
  • Dental Screening Form
    Required at 5-6yo for Kindergarten entry
  • Sports Participation Physical
    Physical must be completed to participate in any school sponsored sport
• Lice Information and Management
  • Head Lice 101
  • Parent Letter
  • Center for Disease Control and Prevention
    Lice information / recommendation for schools
  • American Academy of Pediatrics
    2010 Clinical Study Results and Recommendations
• Fitnessgrams
  • Fitnessgram Example
    Each year elementary students participate in fitness testing through their PE class. This is an example of the fitness report that is generated from their individual results.