SCHOOL NURSE FORMS

Medication Authorization Form

Health History & Emergency Contacts

Medical Exemption Certification Form

Religious Exemption Certification Form

Health Assessment Record (Athletics Physical Form)

Immunization Record

Trade & Athletics: Activity Restriction, Return to School Clearance

Individualized Health Care Plan: Pregnancy/Nursing

Individualized Care Plan: Orthopedic Nursing

Classroom Emergency Plan: Seizure

Classroom Emergency Plan: High Blood Sugar

Classroom Emergency Plan: Low Blood Sugar

Classroom Emergency Plan: Allergy-Anaphylaxis

Classroom Emergency Plan: Breathing Difficulty

Classroom Emergency Plan: Potential for Prolonged Bleeding

Classroom Emergency Plan: BLANK

SCHOOL NURSE RESOURCES & POLICIES

Addendum 5: Interim Guidance for Responding to COVID in CT Schools

Use of Automatic External Defibrillators (AED) Policy & Procedures

Medication Administration Policy