Health Services Forms
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Release of Student/Staff Medical Information (English and Spanish)
This form is used to obtain information from providers to assist with healthcare planning while in school./
Este formulario se usa para obtener
información de los proveedores para
ayudar con la planificación de la
atención médica mientras está en la escuela. -
Hearing Referral Form
This form is used by the healthcare provider to document the results of a hearing examination. It must be returned to the nurse.
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Hearing Referral Form (Spanish)
Este formulario es utilizado por el proveedor de atención médica para documentar
los resultados de un examen de audición. Debe ser devuelto a la enfermera. -
State Eye Exam Form
This form is used when a student fails a vision screening and will need a eye exam.
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Basic Individualized Healthcare Plan
This is a generic healthcare plan form that can be used for any condition requiring modifications while the student is in school.
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MEDICATION AUTHORIZATION FORM (English and Spanish)
This form is completed by parents/quardians for consent to adminsiter medications at school. This link contains the English and Spanish documents.
SISD Medicaiton Authorization Form 23-24 ENG and SPAN.pdf 165.72 KB (Last Modified on July 31, 2023) -
Documenting History of Illness Chicken Pox/ Documentación del historial de enfermedad: Chicken Pox
The purpose of this form is to document immunity to varicella disease due to history of disease in lieu of receiving the vaccine.
El propósito de este formulario es documentar la inmunidad
a la enfermedad de varicela debido a antecedentes
de enfermedad en lugar de recibir la vacuna.