healthforms

This form must be completed by the doctor at the time of your child’s physical exam. The Child’s Health History form must be signed and dated by the physician and returned to the Visitation Health Office. All immunizations (baby shots to the present) must be included.

Consent to Share Student Health Data

This form will allow the Health Office staff to share health concerns with appropriate school personnel who have direct contact with your student during the school day. If we do not have your authorization to share your child’s health concern we are unable to notify the staff that have contact with your child such as the teacher, coach, specialist etc.

Consent for Administration of Medication in School

This form must be signed by both the parent and the physician in order for your child to receive medication in school. This form is for daily medication that your child may be receiving as well as medication they may need to take on an as needed basis. Only medications prescribed by a physician, in writing, will be dispensed in the Health Office. This includes all over-the-counter medications such as Advil and Tylenol.

Sports Qualifying Physical Exam

This form is for all athletes participating in a High School League sport grades 7-12. A physical exam is required every three years. Coaches will exclude athletes who are not in compliance with this Minnesota State High School League requirement. Please return all Sports Physicals to the Athletic Office.

Pupil Health Immunization Record

This form is to complete or update all immunizations that are not on file in the Health Office. If you are not sure of your child’s immunization status please feel free to call the Health Office.

Food Allergy Action Plan

This form is to be completed if your child has any food allergies.

Epi-Pen Letter

This form is to be completed and signed by the physician authorizing the Health Office Staff to administer the epi-pen to your child.

Asthma Questionnaire

Asthma Action Plan

This form is to be completed if your child has asthma. This form is helpful to the Health Office Staff in understanding your child’s needs while at school. This form is in addition to the Administration of Medication in School form, which must be signed by the doctor and the parent for the medication your child will be taking for her/his asthma.

Parent/Guardian Diabetes Questionnaire

This form is to be completed for your child with diabetes along with the Diabetic Care Plan. These forms are in addition to the Administration of Medication in School form, which must be signed by the doctor and the parent for the medication your child will be taking for her/his diabetes.

Please contact the Health Office at 651-683-1708 if you have any questions.