Forms

State law requires any medication or medical procedure have physician order and parent permission in writing. Click one of the following to download and complete the form in either PDF or Microsoft Word format.

PDF version

Student Health History and Home Hospital Forms

Student Health History (pdf, 119kb)
H-H_Instructions_to_Families.pdf
Request_for_HH_Instruction_7.15.15.pdf

Physician's Orders for Medication at School

Physician's Orders for Medication at School (pdf, 6kb)
Orden del médico para administrar medicamentos en la escuela (pdf, 62kb)

Asthma

Health Care Provider Medication Request and Treatment Plan for Asthma (pdf, 80kb)

Diabetes

Health Care Provider Orders for Students with Diabetes in Washington State Schools (pdf, 21kb)

HIPPA Release and Other Health Concerns

Return to School After Concussion (pdf, 124kb)                                      HIPAA Auth for Release.doc
 
Rogers High School Based Healthcare Forms

 Consent for Service.docx
 RHS_Teen_PC_and_Health_Promotions_Services_Flyer_-_29Jan16.pdf

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