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Forms

A-C

AED Check Form
Ambulance Protocol
Anaphylaxis Action Plan
ARDS Form
Asthma Informational Sheet
Asthma Action Plan
Audiometer Monthly Biological Calibration Check

Authorization from Physician for Medication Administration During School Hours
Bus Accident Report

Care Plan Request (LVN only)
Chickenpox Prior Illness
Clinic Sign Out
Color Codes
Consent for Release of Medical Info: English and Spanish

D – I

Daily Medication Administration
Delinquent Immunization Letter to Parents
Documenting History of Varicella Illness
Doctors Referral for ILIs

Emergency Bag Supplies

Emergency Oxygen Inhalator
Employee Assessment by School Nurse
Epinephrine competency Skill Checklist

Fifth Disease

Field Trip Medication Training Form for School Personnel
Food Allergy Protocol

Gastric Tube Feeding Orders
Gastrostomy Feeding Log
Head Lice Notice
Head Lice Letter in Classroom
Head Injury Notice
Health Record

Health Records Management Schedule 

Health Services Dept – Nurse Clinic Staff Information

Incident Report – Medication Administration
Infectious Disease Report

L – M

 

Local Agencies for Immunizations
Med Log
Medical History and Emergency Information
Medication Declination Letter

Medical Information Request Form
Medication PRN Documentation
Medication Reports Instructions
Medication Stop Documentation
Medication Training Form
Monthly Maintance Checklist

N – P

New Inventory List
Notice of Conjunctivitis
Notification Call Tree
Nurse/Nurse Assistant List
Nurse Observation Form
OTC Expired Medication Inspection Sheet
Parent Notification of Clinic Visit
Pertussis Letter
Physical Education Recommendations
Physician Referral
Physician’s Order for Gastric Tube Feeding
Procedures for Students that are not Potty Trained

Provisional Enrollment
Purchase Order Requisition Form

R – U

Rabies protocol

Report Due Dates   
Request Food Allergy
Request Food Allergy (Spanish)
Request to Administer Vaccination
Request and Consent for Administration of Prescription Medication- English

Request and Consent for Administration of Prescription Medication- Spanish
School Feeder Pattern

School Nurse Back Up List

Screening Referral Form
Seizures Action Plan

Six Step Decision Making
Special Diet Form

Special Procedure Training Form
Standing Orders
Substitue Form
Summer School Protocol
Student Medication Disposal Log
TB Questionnaire English and Spanish

Texas Immunization Requirements
Training for Special Procedures
Universal Precautions Guidelines