Documents that provide information about medical conditions and care

The school district uses various forms to track important health information about students in the district. These forms provide information for school nurses that is critical to the safety, health and wellness of all students and staff.

Required forms

Before the student starts school

These documents must be completed and turned in to the school before the student can attend school:

• Certificate of Immunization Status (CIS): State law requires this record of the student's vaccinations.

Chinese Translation | Russian Translation | Spanish Translation | Vietnamese Translation

OR

• Certificate of Exemption (COE): Shows that your child is exempt from school, child care and preschool immunization requirements.

Chinese Translation | Russian Translation | Spanish Translation | Vietnamese Translation

Students with life-threatening allergies or conditions must complete the required forms that are specific to their illness before they can start school. Forms include:

• General Individual Care Plan
• Allergy Individual Health Plan/Emergency Care Plan
• Asthma Individual Health Plan/Emergency Care Plan
• Cardiac Emergency Care Plan
• Diabetes Low Blood Sugar Individual Health Plan/Emergency Care Plan
• Seizure - Individual Health Plan/Emergency Care Plan

Upon starting school

• These documents need to be turned in when the student begins school:
  • Nurse Alert form: The district nurses use the information from the Nurse Alert forms to plan for a student's health care while at school. Spanish Translation
  • Authorization to Administer Medication: If your child needs prescription or nonprescription medication during the school day, an Authorization to Administer Medication form must be completed (one form required per medication).
    • Health Care Provider Orders for Epinephrine Administration
• This document needs to be turned in prior to the student beginning middle school:
  • Tdap Form for Middle School Students

Optional Forms

• Authorization for Release of Records/Information: Allows school nurses to contact student's health care provider about their care.
• Seattle Children's Hospital Release of Information Requests