Student Health Forms

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.
  Translations: Chinese | Russian | Spanish | Vietnamese

OR

• Certificate of Exemption (COE): Shows that your child is exempt from school, child care and preschool immunization requirements.
  Translations: Chinese | Russian | Spanish | Vietnamese

Students with life-threatening allergies or conditions

Required forms that are specific to a student's illness must be completed before they can start school. Forms include:

• General Individual Health Plan (IHP)
• Allergy Individual Health Plan (IHP)
• Asthma Individual Health Plan (IHP)
• Cardiac Individual Health Plan (IHP)
• Diabetes low blood sugar Individual Health Plan (IHP)
• Seizure - Individual Health Plan (IHP)

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
  • 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).
    • Medication administration authorization
    • Epinephrine administration authorization
    • Inhaler administration authorization
    • Seizure administration authorization

Optional Forms

• Authorization for release of records/information: Allows school nurses to contact student's health care provider about their care.
• LWSD discontinuation of medication: Required to remove a student from the exclusion list if they previously had emergency medications for seizures, allergies, asthma or any life-threatening condition. 
• Seattle Children's Hospital release of information requests