Nursing Resource Pages

COVID-19 FORMS

COVID-19 Screening Tool

COVID-19 Symptom Exemption Form for Chronic Condition

Student Mask Exemption/Modification Form

Back to School Note

504 Referral Form

AED Incident Report Form

AED Monthly Inspection Form

Alaska Medical Exemption Form

Alaska Religious Exemption Form

Allergy Action Plan

Animal Bite Incident Form

Asthma Action Plan

Asthma Supplementary Treatment Orders

Child Abuse/Neglect Reporting Form

Diabetes Care Plan_Injection

Diabetes Care Plan_Pump

Diabetes Care Plan_School and Parent Agreement

Diabetes Care Plan_Student Agreement

Emergency Action Plan

Epinephrine Administration Tracking Form

Field Trip Staff Authorization to Administer Medication

Gastrostomy Tube Feeding Log

Head Injury Instruction Sheet

Head Injury Instruction Sheet when NO nurse in the building

Health History Form

Hearing Referral Form

Individual Health Care Plan Template

Medication Inventory Form

****Parent Acknowledgment of Unlicensed School Staff Administering Medication (RETIRED FORM NO LONGER NEEDED)

Parent Request to Train Unlicensed School Staff to Administer Non-Delegable Medication

Provisional Enrollment Form

Release of Immunization/TB Records

Release of Information

Request for Administration of Medication for Asthma/Anaphylaxis

Request for Administration of Medication (Long Term)

Request for Administration of Medication (Short Term)

Request for Medical Information for Section 504 Evaluation

Request for Specialized Nursing Service

Seizure Action Plan

Seizure Observation Record

Vision Referral