Updated May 31, 2019
Health Forms and Documents
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Emergency Medical Form (Required) 2019-2020
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Immunization Record Form 2019-2020 (Required)
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Immunization Waiver 2019-2020
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Student Health Information Form 2019-2020
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Authorization for Self-Carry Administration of Medication Form 2019-20
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Authorization for School Personnel Administration of Medication Form 2019-20
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Asthma Management Form
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Diabetes Medical Management Form
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Food Allergies (or Bee Stings) Action Plan Form
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Seizure Action Plan Form
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OHSAA Pre-participation Physical Evaluation Form 2019-20 (Athletics)
- Ohio CDC Interscholastic Concussion Form 2019-20 (Athletics)
Procedures
Health Conditions
Parents: If you indicated on the Emergency Medical Form that your child has a health condition, please complete all applicable health and medication forms, and return them to the school nurse. This information and medication authorization is mandatory for students who need medication at CJ.
All students with health conditions need the Authorization for Self-Carry Administration of Medication Form and Authorization for School Personnel Administration of Medication Form (both listed above) completed as well as the following form(s) coinciding with the student's condition:
ASTHMA
- Complete and submit asthma form
- Obtain medical authorization for the applicable medication form(s) to both self-carry and self-administer an inhaler, or to have an inhaler available in the clinic for use, or both. Medication must be labeled and dispensed in the original container.
DIABETES
- Complete and submit the Diabetes Medical Management Plan Form
- Obtain medical authorization for any medications to be given at CJ
FOOD ALLERGIES OR BEE STING ALLERGIES
- Complete and submit the Food Allergy Action Plan Form
- If your student has an allergy to bee stings, complete and submit the Food Allergy Action Plan Form, but cross out food allergy, and write in “BEE STING.”
- Obtain medical authorization for the applicable medication form(s) to both self-carry and self-administer an EpiPen, or to have an EpiPen available in the clinic for use, or both. Medication must be labeled and dispensed in the original container.
SEIZURE DISORDER
- Complete and submit the Seizure Action Plan Form
- Obtain medical authorization for any medications to be given at CJ