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 Microsoft Word version

Student Health History and Home Hospital Forms

Student Health History (pdf, 119kb) Student Health History (Word doc, 25kb)
H-H_Instructions_to_Families.pdf
Student Health History - (Spanish)
Request_for_HH_Instruction_7.15.15.pdf
H-H_Instuctions_to_Health_Care_Provider_print_on_light_blue.pdf

Physician's Orders for Medication at School

Physician's Orders for Medication at School (pdf, 6kb) Life Threatening Allergy Medication Orders.docx
Orden del médico para administrar medicamentos en la escuela (pdf, 62kb) Orden del médico para administrar medicamentos en la escuela (Word doc, 32kb)

Asthma

Health Care Provider Medication Request and Treatment Plan for Asthma (pdf, 80kb) Health Care Provider Medication Request and Treatment Plan for Asthma (Word doc, 48kb)

Diabetes

Health Care Provider Orders for Students with Diabetes in Washington State Schools (pdf, 21kb) Health Care Provider Orders for Students with Diabetes in Washington State Schools (Word doc, 31kb)

HIPPA Release and Other Health Concerns

Return to School After Concussion (pdf, 124kb) HIPPA_Release.pdf
 
Rogers High School Based Healthcare Forms

 
 Consent for Service.docx  RHS Release of Info DD2870.pdf
 RHS_Teen_PC_and_Health_Promotions_Services_Flyer_-_29Jan16.pdf  

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