Seattle Public Schools

Student Family Portal
Health Services
Seattle Public Schools/Departments/Health Services/Forms

Forms

SPS Health Services Forms

Some of these forms can be completed online, saved, and then attached to an email. Other forms must be printed then either scanned and emailed, faxed, or mailed.

Annual Student Health Information Update

Authorization for Medications Taken at School

State and 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.
Medication must be labeled properly and in its original pharmacy container.
This form needs to be renewed at the beginning of each school year.

Authorization for Treatments and Procedures Performed at School

Gives permission for an authorized person to assist a student by performing a specific treatment or procedure.

Diet Prescription for Meals at School

If your student has a non-life-threatening food allergy or medical condition that requires food accommodations at school, please fill out the following form(s).

If food modifications or accommodations are requested

If food modifications or accommodations are requested, the following forms are required:

  1. Diet Prescription Form
  2. Food Allergy Assessment Form
If food modifications or accommodations are not needed

If food modifications or accommodations are not needed, the following form is required:

  1. Food Allergy Assessment Form

If your student has a severe or life-threatening food allergy, please see relevant forms under Health Conditions.  Please submit completed forms to your student’s school nurse.  

Extraordinary Nursing Support

Field Trip/Outdoor Education Information and Release

Field trips are an educationally sound and important component in the instructional and/or athletic programs of schools.

Your student’s teacher and school nurse will partner and communicate with you about required authorization and health forms.

Health Conditions

Diabetes

Students with Diabetes

Diabetes Assessment Form

Seizures

Students with Seizures

Seizure Assessment Checklist

Severe or Life-Threatening Allergies

If your student has severe or life-threatening food allergies, please fill out the following form(s). Students with severe or life-threatening food allergies are required to have documentation filled out by parents/guardians and signed by a licensed health care professional on or before the first day of school. Please submit completed forms to your student’s school nurse.

Severe Allergy/Anaphylaxis Medication Order and Health History Form

This is the district preferred form. This form contains all required documentation. It must be renewed annually:

Alternatively, parents/guardians can provide the following forms. All three forms must be completed together:

  1. Food Allergy Assessment Form
  2. Authorization for Medications Taken at School Form
  3. Diet Prescription Form

For non-life-threatening food allergies, see Diet Prescription for Meals at School.

Severe or Life-Threatening Asthma

Students with Asthma

Asthma Assessment Form for School

Asthma Medication Order and Health History

Home/Hospital Instruction

  • Home/Hospital Instruction – is a state (OSPI) program that provides funding for schools to provide limited scholastic support to students with a health issue. To qualify, students must be expected to miss at least four (4) weeks of school, but no more than eighteen (18) weeks. In case of chronic illness, the services can be intermittent (Please indicate this on the application form). The form must be signed by the parent/guardian and the health care provider.
  • Pregnancy and Postpartum – the “usual and customary” weeks of postpartum service 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.
  • Please note that Health Services merely verifies the student’s eligibility for services and serves as a pass through for funding from OSPI.  The school is responsible for finding a tutor and setting up the educational plan.
  • There are strict requirements for reimbursement from OSPI for this funding so if/when the request is approved, please read the instructions carefully as  we cannot fund services until H/H is approved.  Buildings will be responsible for any expenses incurred beyond the limits of the program.
  • Special Education Students – IMPORTANT: If a student cannot attend school because of a need related to his/her qualifying special education condition, do not submit a Home/Hospital application until after contacting the school’s Section 504 coordinator and the IEP responsible staff for that student.  Special Education manages funding for IDEA students who require Home Hospital support.
  • Home/Hospital Guidelines
  • Home/Hospital Application (English)
  • Home/Hospital Application (Spanish)
  • Home/Hospital Instruction Sheet

Immunizations

Release of Health Care Records (Mutual Exchange)

Gives Seattle Public Schools and a health care provider, hospital, or clinic permission to exchange information about a student.

*UW/Harborview requires authorizations in English

Sexual Health Education

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.

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.