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Health Office Forms

**General Forms**
Health Questionaires New to district and kindergarten students please complete the health questionnaire indicated below. All required forms may also be obtained from the health office during site registration.
Health History and Physical Assessment Questionnaire (Kdg/new to district K-5) Health Questionaire (yearly update grades 1-12) Release of Confidential Information Secondary, Long Health Questionnaire (new to district Grades 6-12) Other Forms Medication Permission Form (see medications at school page for all medication forms)
Health Care Plans & Related Forms (Only as needed or requested)
A health plan is a plan developed by the school nurse with the assistance of the parent for the management of a student's health concern at school. The following plans are available as fill-in-the-blank forms and can be filled in by the parent, SIGNED, and returned to the school health office for use. Note that the asthma and allergy state plans require a doctor signature to order the emergency medications included in the plans. Return those forms after the doctor has also signed it. The school nurse will contact you if further information or clarification is needed. Other health conditions requiring plans must be written by the school nurse on an individual basis. Please contact the school nurse at your student's school for assistance.
Allergy Informational Letter Primary Grades Allergy Informational Letter Secondary Grades Allergy-Anaphylaxis Plan Form Allergy-EPI-Pen Contract Asthma Contract Asthma Emergency Plan Asthma Informational Letter Primary Grades Asthma Informational Letter Secondary Grades Diabetes Contract (Secondary Grades) Diabetes Orders and Forms Health Questionaire for a Student with Asthma or Breathing Problems Seizure Disorder Plan
School Physicals
School health services are meant to augment, not replace, annual health care supervision by your student's primary health care provider. Therefore, the district requests that students entering kindergarten, fourth, seventh, and tenth grades have a physical examination. A physical form is available from your school, on the Thompson School District web site (Health Services Department), and at most local doctors' offices. The examination should be performed by the student's family physician and at no cost to the school district.
School Physical Form

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