School District
If it is to be, it is up to me!
-William H. Johnsen

Health Office Forms

Forms may be completed on-line then printed out and sent in to school or brought to healthcare provider for completion as appropriate

hof1 Food Allergies (both forms below need to be completed)
Food Allergy Treatment Plan—completed by healthcare provider
Allergy Assessment—completed by parent
hof2 Asthma (all three forms below need to be completed)
Asthma Treatment Plan—completed by healthcare provider
Asthma Medication Authorization—completed by parent
Asthma Assessment for Parents—completed by parent
hof3 Tylenol/Motrin Form
Daily/PRN Medication Form—completed by parent and healthcare provider


hof4 Flu/Influenza Vaccine Form—preschool only
Meningococcal and Tdap Vaccines
—entering 6th grade only

Other Forms

hof5 Student Physical Exam—required for school entry, completed by healthcare provider
Health History — required for entrance to kindergarten or pre-K, completed by parent
Health History Update — required annually, completed by parent
Medical Procedure Permission—completed by healthcare provider
hof6 Seizure Disorder (both below need to be completed)
Seizure Questionnaire — completed by parent
Seizure Action Plan — completed by healthcare provider

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