Forms & Applications
Parents, Health Care Providers & Others May
Use
These
forms will require you to use Adobe Acrobat to view or print. This
is a free
download.
Anaphylaxis
Go
to Life-Threatening
Health Conditions. Note special section for anaphylaxis under
this heading.
Certificate of Immunization Status
(CIS)
State of Washington's form used by parent/guardian to
report immunization information for their student. See Immunization
Requirements for Washington State's requirements for school
attendance.
Some students
(e.g., kindergarten) may need to complete the immunization
requirements after registration and before the start of school.
(more information)
Diet Prescription
for Meals at School
Health care provider must complete and sign that the student
needs special school meals prepared or served because of the
student's disability or chronic medical condition.
Disability
If your
child has a disability s/he may qualify for services under Section
504 of the Rehabilitation Act of 1973. See Helpful
School-Related Information for more detail.
Employment
School nurses must have a BSN as a minimum qualification.
LPNs work in a limited capacity.
Field Trip/Outdoor
Education Information & Release
Emergency contact information, medical concerns, and
authorization to receive emergency medical or dental care while
away from the school. Must be signed by a
parent/guardian.
Health
Registration -- revised 8/02
Information provided by a parent/guardian giving
emergency contact information and alerting the school nurse to
health issues.
Home/Hospital
Instruction
A state (OSPI) program
that offers limited scholastic help to students expected to miss at
least four (4) weeks of school for one condition, but
no more than eighteen (18) weeks. Can be intermittent absences
in cases of chronic disease.
The "usual and
customary" weeks of postpartum service OSPI expects to see are six
(6) for a routine vaginal delivery and eight (8) for a c-section.
Please do not exceed those numbers without indicating a reason the
student is unable to attend classes because of her own medical
needs.
Cannot be used to
serve special education students for conditions related to their
qualifying condition; contact Special Education in those
cases.
See Helpful
School-Related Information for more details.
Life-Threatening Health
Conditions
Washington State law
requires that when there is a student with a known life-threatening
condition schools must be prepared for a life-threatening event on
the day the student starts school.
Please be sure you
have completed the following forms and bring medication(s) to
school if your student has a known life-threatening
condition:
The following are
action plan and checklists for use with students with anaphylactic
allergies.
Medication at
School --
revised 12/11/02
State or 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 Helpful
School-Related Information for more detail.
Mutual Exchange
-- revised
11/27/02
Gives Seattle Public Schools and a health care provider,
hospital, or clinic permission to exchange information about a
student.
State-Required
Annual Notice
Washington
State law requires that parents/guardians of students in grades
6-12 be provided information about meningococcal disease and Human
Papillomavirus (HPV) and the availability of a vaccine. Please
include the following in your back-to-school packets each
year.
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.
Applications 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.
Treatment
& Procedure Authorization
Gives
permission for an authorized person to assist a student by
performing a specific treatment or procedure.
