Optional Health Forms

• Over the Counter Medication Forms - to be completed by Guardian
  
  

• Prescription Medication Forms - to be completed by physician and Guardian
  
  

• Emergency Medication Form - to be completed by physician for medications used for Asthma, Allergies, Seizures, etc. 
  
  

• Physician Certification to Authorize Student Self Administration of Emergency Treatment at School  - to be filled out by Physician
  
  

• Consent to Release Information
  
  
  
• Click Here for Information about School Action Plans for chronic illnesses or allergies.

 

Questions? Please email the LSCS District Nurse - Jennifer Pavlinac RN, BSN at jpavlinac@lakes.k12.in.us