Medical Forms/Health Info

Please ask the JICHS front office for, or download and print from below, medical forms for your student. Most forms must be signed by a physician.

2024-2025 Parent Letter

Allergy and Anaphylaxis Emergency Care Plan and Medication Orders

Allergy Self-Carry

Confidential Health Information

Diabetes

Non-Medical Exemption

Over-the-Counter Meds Information

Permission for Medication

Self-Carry for Inhalers and Epipens

Vision and Hearing Screening

Does my student require a medical form?

Your student has asthma. Asthma HCP will need to be completed.

Your student has asthma and will be carrying an inhaler on campus. Asthma Contract to Carry will need to be completed.

Your student has allergies. Allergy Emergency Plan will need to be completed.

Your student has allergies and will have an Epi-pen on campus. Epi-Pen Contract to Carry will need to be completed.

Your student has diabetes. Diabetic HCP will need to be completed.

Your student has or will need medication, including cough drops or medicine for headaches, to be taken during the school day.

Student Medication form and Cough Drop Carry Contract will need to be completed.

You would like your student to receive mints or crackers on an as-needed basis from clinic. Student Medication form will need to be completed.

Your student has medical concerns that may need to be addressed during school hours. Confidential Health Information form will need to be completed.

*HCP –Health Care Plan