Health Forms

  • Asthma Action Plan

    The Asthma Action Plan allows parents and students to work with medical providers to create a plan for management of asthma and administration of medication while students are at school. This form must be completed by a medical provider and signed by a parent or guardian.

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  • Diabetes Management Plan

    The Diabetes Management Plan must be completed by a licensed medical provider. This form includes information about the treatment plan, medication administration, and emergency plan for students diagnosed with diabetes.

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  • Emergency Action Plan - Seizures

    The Emergency Action Plan for seizures is a form that parents can complete to give school staff information about a student's history of seizures, medications, and how to respond to a seizure.

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  • Emergency Action Plan - Severe Allergy

    The Emergency Action Plan for severe allergy is a form that parents can complete to give school staff information about a student's history of allergic reactions, specific list of allergens, plans to protect the student from allergens at school, and how to respond to an allergic reaction.

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  • Medication Authorization for Students

    The Medication Authorization form should be completed by a licensed medical provider and signed by a parent or guardian. This completed form is required for any prescription or over the counter medications to be administered to students by school staff.

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  • NC Health Transmittal Form

    The North Carolina Health Transmittal form must be completed by a licensed medical provider and is required for all students enrolling in a NC public school for the first time.

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  • NC Immunization Requirements

    NC Immunization requirements for School Entry - NC G.S. 130A 152 (a)

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  • NC Medical Statement Diet Order

    The Medical Statement for Students with Unique Mealtime Needs for School Meals helps schools provide meal modifications for students who require them. Schools cannot change food textures, make food substitutions, or alter a student’s diet at school without proper documentation from the healthcare providers. Completion of all items will allow your child’s school to create a plan with you for providing safe, appropriate meals and snacks to your child while at school.

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  • NCHSAA Gfeller Waller - Return to Learn/Play Forms

    The purpose of the Gfeller-Waller Concussion Policy is to protect student-athletes in North Carolina. If any student athlete is diagnosed with a concussion, these forms must be completed by a licensed healthcare provider.

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  • Return to Learn Form

    The Return to Learn form should be complete by a licensed medical provider for any student who has been diagnosed with a concussion. This form describes what accommodations are needed in the school learning environment when a student has been diagnosed with a concussion.

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  • Specialized Healthcare Procedure Order Form

    The Specialized Healthcare Procedure form must be completed by a licensed medical provider and signed by a parent or guardian. This form should be used for healthcare procedures that will be performed at school (examples: urinary catheterization, Gtube care and feedings, Vagal Nerve Stimulator, ostomy care). Please check with your student's school nurse if you are unsure of whether this is the form that your student will need for a procedure to be performed by school staff.

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  • Student Health Information

    Parents are responsible for providing the school with any medication or medical equipment that is needed to care for their child during the school day. If there are any changes to your child's health condition during the school year please inform the school nurse ASAP.

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