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Health Chart Requirements 2020-21

Birth Certificates, Immunizations, physicals and option forms

Paula Davis RN

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REQUIRED FORMS FOR ELEMENTARY

  1. State copy of a birth certificate (http://www.kdheks.gov/vital/birth howto.html) we cannot accept hospital courtesy certificates.
  2. Physical Examination Form (performed and signed by a health care provider) must include a review of systems.Sports physicals must be after May 1st of the prior school year to qualify. KSHSAA has a new form for 2020-2021.
  3. Immunization Records (a copy from your health care provider or the health department) or need for immunizations.
  4. Student Health Information checklist form.

OPTION FORMS (SOME MAY BE NECESSARY FOR YOUR STUDENT)

  1. OPT OUT.  McLouth will conduct vision, hearing and dental screenings for students. Parents that wish to have their child EXCLUDED from screenings must submit in writing by  September 15th of every year that they DO NOT want their child screened.  Please include your child's name, grade, which screening you do not want to participate in and your signature. 
  2. Medication Administration Request for students needing to take Prescription medication at school. Examples: ADHD medication at lunch time. Antibiotic that can’t be moved to afterschool.
  3. Asthma Intake and Action Plan. Elementary students who have asthma are REQUIRED to have an Asthma Action Plan on file signed by a physician. Elementary students are allowed to “Keep in the classroom” emergency medications with the proper forms on file and a physician’s request to do so. Example: Doctor’s note requesting inhaler to be kept in the classroom. These medication’s will not go back and form. They will be kept in a secure locked location in the classroom. Please see Asthma Management in the School Setting.
  4. Severe Allergy Action Plan.   Elementary students who have Severe Allergies, requiring an epi-pen, are REQUIRED to have a Severe Allergy Action Plan on file signed by a physician.  Elementary students are allowed to “Keep in the classroom” emergency medications with the proper forms on file and a physician’s request to do so. Example: Doctor’s note requesting epi-pen be kept in the classroom. These medication’s will not go back and form. They will be kept in a secure locked location in the classroom.
  5. Physician order for emergency medications not listed above. Examples would be: Insulin, glucagon, diastat, enzymes necessary for digestion, migraine medication and any medication deemed “Keep in the classroom”. A Doctor’s note requesting the medication be kept in the classroom is necessary. These medication’s will not go back and form. They will be kept in a secure locked location in the classroom.

REQUIRED FORMS MS/HS

  1. State copy of a birth certificate (http://www.kdheks.gov/vital/birth howto.html) we cannot accept hospital courtesy certificates.
  2. Physical Examination Form (performed and signed by a health care provider) must include a review of systems.
  3. Immunization Records (a copy from your health care provider or the health department) or need for immunizations.
  4. Student Health Information checklist form.

OPTIONAL FORMS MS/HS (SOME MAY BE REQUIRED FOR YOUR STUDENT)

  1. OPT OUT. McLouth will conduct vision, hearing and dental screenings for students. Parents that wish to have their child EXCLUDED from screenings must submit in writing by  September 15th of every year that they DO NOT want their child screened.  Please include your child's name, grade, which screening you do not want to participate in and your signature. 
  2. Medication Administration Request for students needing to take Prescription controlled substance at school. Examples: ADHD medication at lunch time. Narcotic pain medication after a surgery. 
  3. Over-the-counter medications (Tylenol, ibuprofen, cough drops, etc.) may be carried and self-administered by MS/HS students without written parent and/or physician signature.
  4. Asthma Intake forms and Action Plan. Middle and high school students who have asthma are REQUIRED to have an Asthma Action Plan on file signed by a physician. All MS and HS students are allowed to self-carry emergency medications with the proper self-carry forms on file and a Physician's signature. Please see Asthma Management in the School Setting.
  5. Severe Allergy Action Plan.   Middle and high school students who have Severe Allergies, requiring an epi-pen, are REQUIRED to have a Severe Allergy Action Plan on file signed by a physician. All MS and HS students are allowed to self-carry emergency medications with the proper self-carry forms on file and a Physician's signature. 
  6. Self-carry Forms for medications for emergencies not listed above. Examples would be: Insulin, glucagon, diastat, enzymes necessary for digestion, migraine medication and any medication deemed self-carry by a physician. These REQUIRE a Physician's order.