Forms & Applications
Parents, Health Care Providers & Others May
Use
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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 Exemption (COE) to Immunization
Requirements
Certificate of Immunization Status (CIS)
State of Washington's form used by parent/guardian to report
immunization information for their student. See Washington
State's requirements for school attendance.
Some
students (e.g., kindergarten, 6th grade) 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 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.
