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Health & Safety - Nursing Program


Forms & Applications


A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Some of these forms can be completed on line, saved, and then attached to an email (see contact information).  Other forms must be printed then may be scanned and emailed, faxed, or mailed.

Anaphylaxis 
- return to top
Go to Life-Threatening Health Conditions.  Note special section for anaphylaxis under this heading.

Certificate of Exemption (COE) to Immunization Requirements
Beginning with applications received after 7/22/2011 exemptions require both parent/guardian and health-care provider's signature except for certain religious exemptions.
Certificate of Immunization Status (CIS) - return to top
Washington State form used by parent/guardian to report immunization information for their student.  See Washington State 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 - return to top
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.  Employment - return to top
School nurses must have a BSN as a minimum qualification.  LPNs work in a limited capacity.  Field Trip/Outdoor Education Information & Release - return to top
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 or guardian. Health Packet - return to top Health Registration - revised 8/2014
Information provided by a parent/guardian giving emergency contact information and alerting the school nurse to health issues.  This form may be requested by the school each school year in order to keep current with your child's health information. HIV / AIDS Education Home/Hospital Instruction - return to top
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.  This must be indicated on the form.

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.

Students cannot be served again for the same condition.  Contact Special Education or consider 504 accommodations in those cases.

See Health-Related School Information for more information. Immunization Forms - return to top Life-Threatening Health Conditions (Health Packet) - return to top
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.  This would include the necessary forms from the health care provider as well as any needed medications.  These documents need to provide current information so should be prepared after July 1 for the following school year!  Medication at School - revised 8/14
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 Health-Related School Information for more detail.  This form needs to be renewed at the beginning of each school year. Mutual Exchange - revised 11/30/09
Gives Seattle Public Schools and a health care provider, hospital, or clinic permission to exchange information about a student. State-Required Annual Notice - return to top
Washington State law requires that parents/guardians of students in grades 6th-12th be provided information about meningococcal disease and Human Papillomavirus (HPV) and the availability of a vaccine.  Transportation for Medical Reasons - return to top
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. Treatment & Procedure Authorization - return to top
Gives permission for an authorized person to assist a student by performing a specific treatment or procedure.

Contact Us

General Inquiries
SchoolNurses
   @seattleschools.org

(206) 252-0750
(206) 252-0751  fax

Immunization Inquiries
Immunizations
   @seattleschools.org

(206) 252-0763
(206) 252-0751  fax

 

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