Health Services Forms

Health Services Forms

Listed below are a number of forms that are used by the Manheim Central nurses.  Please feel free to print and complete any of these forms at home.
 
Emergency InformationThis form is used to provide emergency contact information for your child.
MCSD Medication AuthorizationThis form is used to give the school permission to administer a medication that is prescribed by a licensed physician.
Asthma Action PlanThis form provides the nursing staff with specific guidelines to manage your child's asthma.
Emergency Health PlanThis form provides the nursing staff with specific guidelines to manage your child's severe allergy.
Physical Form:  Physical exams are required upon original entry to school, sixth grade, and eleventh grade.
Dental FormDental exams are required upon original entry to school, third grade, and seventh grade.
Seizure Action Plan:  This form provides the nursing staff with specific guidelines to assist your child with seizure monitoring and treatment.
Free ImmunizationsThis form provides information on free immunizations for children with no medical insurance or those who are enrolled in Medical Assistance.
 
 
Copyright 2011 by Manheim Central School District