Health Services

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 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.

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

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.

See Seattle Public Schools Nutrition Services website for Food Allergies and Special Diet Requests.

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.

Important Medical Information Form (to be updated)

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.
  • Guidelines
  • Home Hospital Application
  • 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.

Sexual Health Education

School-Based Health Centers

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.