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You Are Here:  Home  Departments  Educational Services  Ed Services Forms  Health Services Forms

Health Services Forms

Health Services Forms

Health_Services_Forms icon
Health Services Forms
title

FORM NAME
HS-7 Field Trip - Consent to Treat Minor
HS-7-s Spanish Field Trip - Consent to Treat Minor
HS-7a Field Trip - Consent to Treat Adult Volunteer
HS-9b  Health History
HS-9h Oral Health Assessment Form
HS-9h-h Hmong Oral Health Assessment Form
HS-9h-s Spanish Oral Health Assessment Form
HS-11a Physician's Authorization to Administer Medication
HS-11b Parent Request to Discontinue Medication at School
HS-13 Bee Sting History
HS-13-s Spanish Bee Sting History
HS-32 Initial Health, Development and Social History - Full
HS-33 Triennial Health, Developmental and Social History
HS-33-s Spanish Triennial Health, Development and Social History
HS-402 Scoliosis Information Sheet
IMM-222 Parent's Guide to Immunizations Required for School Entry
PM-171A Report of Health Examination for School Entry - English and Spanish
   
  Student Athlete Physical and Code of Conduct
 
California Healthy Kids Survey Parent Permission Forms
Food Allergy, Insect Allergy & Anaphylaxis Emergency Care Plan
 
 
Diabetic Care Packet

Diabetic_Care_Packet iconDiabetic Care Packettitle

FORM NAME
HS-301 Diabetic Individualized School Healthcare Plan (ISHP) Contact Information
HS-302a Diabetic Individualized School Healthcare Plan (ISHP) School Nurse Assessment page 1
HS-302b Diabetic Individualized School Healthcare Plan (ISHP) School Nurse Assessment page 2
HS-303a Diabetic - Physician's Orders page 1
HS-303b Diabetic - Physician's Orders page 2
HS-304 Diabetic Care Plan Summary - Non-Pump
HS-305 Diabetic Care Plan Summary - Insulin Pump
HS-306 Diabetic Individualized School Healthcare Plan (ISHP) Equipment and Supplies
HS-307 Diabetes Information Letter for Parents
HS-308ab Diabetes Protocol
HS-313 Hyperglycemia / Hypoglycemia Symptoms Chart
HS-314a Weight Referral 5th Grade Student Referral
HS-314b Weight Referral Secondary Student Referral
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Chico Unified School District
1163 East Seventh Street,
Chico, CA 95928-5999
(530) 891-3000
(530) 891-3220
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