Forms

Back to School Help Fair Flyer:

Back to School HELP Fair 2024 Flyer4.25.24

Physical Form:

Child Health Exam Form Revised 01 31 2024 (1)

SPORTS PHYSICAL FORM  (This can’t be used for the school physical)

Dental Forms:

Dental Exam Form 2022

Dental Exam Form 2021 Editsspanish Final

Dental Exam Waiver 2021 Editsspanish Final

Dental Exam Waiver 2021

Kindergarten Round up forms:

Kindergarten camp letter 2024

Kindergarten Round up Flyer 2024

Meningococcal Form:

ACHD Consent Meningococcal

Wellness Express Forms:

ACHD School Consent 7.12.18

SIU Consent Required For All Physicals

Allergy Policy and Forms:

Guideline For Management Of Children With Life Threatening Allergies Revised 2019

Allergy Medical Management Plan (Action plan plus orders)

Physician Statement For Food Substitution

Girls Talk Outline:

Girls Talk Outline

Asthma Forms:

Asthma Medical Management Plan (Action plan and orders)

Asthma Questionnaire

Parental Authorization Request For Self Administration Of Asthma Inhaler

Seizure Forms:

Seizure Medical Management Plan (Action plan and orders.)

Seizure Questionnaire

Diabetes:

DIABETES MEDICAL MANAGEMENT PLAN 

QPS Health App Authorization

Medication Forms:

Authorization and Permission for Administration of Medication 2023

AUTHORIZATION AND PERMISSION FOR SPECIALIZED MEDICAL TREATMENT 

(For Seizure, asthma, diabetes, and allergy orders, please refer to those sections located above.)

Diabetes:

DIABETES MEDICAL MANAGEMENT PLAN 

QPS Health App Authorization

Eye Exam Forms:

2022 Eye Examination Report

2022 Eye Examination Waiver

LEAD QUESTIONNAIRE

Other Forms:

Adams County Health Department

SIU Flyer

Facts about Meningococcal Disease

Meningococcal Vaccine Form

Flu Guide For Parents Brochure

IDPH Disease Guide

Religious Exempt Form