Health Forms & Resources

For your convenience, we’ve gathered frequently used health forms in one place. These include:

• School Entrance Physical
• Immunization Exemption Certificate
• Medication Authorization
• Health Plans for Asthma, Diabetes, Allergies
• Lice Treatment Letters
• Concussion Acknowledgement and Reports

Policy 7-2.3: School Admissions

• School Health Physical Entrance Form (English) (Spanish)
• 7-2.3(B) F2 Certificate of Religious Exemption (for immunizations)

Policy 7-4.2: Interscholastic Athletics

• 7-4.2(A)F1 Acknowledgement of Receipt and Understanding of Concussion Policy
• 7-4.2(A)F2 Professional Referral for the evaluation of a sports related head injury
• 7-4.2(A) F4 Head Injury Report
• 7-4.2(A)F3 Concussion Signs and Symptoms Checklist

Policy 7-5.1: Communicable Diseases

• 7-5.1(A) F1 Letter to Parent/Guardian of Student with Lice
• 7-5.1(A) F2 Lice Treatment Verification Form
• 7-5.1(A) F3 Letter to Parent/Guardian Regarding Follow up Lice Letter 

Policy 7-5.2: Blood Boarne Contagious or Infectious Diseases

• 7-5.2(A) F1 Post Exposure Report Form
• 7-5.2(A) F2 Consent/Non-Consent to Collect and Test Blood Form
• 7-5.2(A) F3 Hepatitis B Vaccine Declination Form

Policy 7-5.3: Administering Medicines to Students

• 7-5.3(A) F1 Authorization for Medication Administration
• 7-5.3(A) F2 Annual Contract for Self-Administration of Medication
• 7-5.3(A) F3 Physician Order/Health Care Plan for Severe Allergy
• 7-5.3(A) F4 Physician Order/Health Care Plan for Diabetes
• 7-5.3(A) F5 Physician Order/Health Care Plan for Asthma
• 7-5.3(B) F1 Report of Anaphylactic Reaction

• SNP Memo No. 2020-2021-62, Updated Dietary Modification Medical Statement Form (Link to VDOE)
  • SNP Memo No. 2020-2021-62 Attachment A (Link to VDOE)