Nurse's Office

This double-sided 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 must be included (baby shots to the present). This form also has a component for all athletes participating in a High School League sport grades 7-12. A physical exam is required every three years and also for all students brand new to Visitation. Coaches will exclude athletes who are not in compliance with this Minnesota State High School League requirement.

For Students Who Take Medication During the School Day:

Administration of Medication in School - Consent Form

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.

Allergies: Health Forms

Food Allergy Forms

Bee Sting Allergy Forms

Forms to be completed by your child's physician, if applicable.

Diabetes: Health Forms

Diabetes Packet
Self-Monitoring Forms

These forms are to be completed for a child with diabetes. The Self-Administration Forms are only for those families wanting their child to self-monitor their own blood glucose throughout the school day. The Diabetes Packet includes a Diabetic Questionnaire, along with a Diabetic Daily Routines Form, and should be filled out by the parent. The Diabetes Packet also includes physician forms, which are called: School Communication and Treatment Authorization for Type 1 Diabetes (2 pages). There is a required equipment list that must be supplied, by you, to our Health Office by the first day of school - this list is at the bottom of the Diabetes Questionnaire. 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.

Asthma: Health Forms

Asthma Inhaler Letter

Asthma Action Plan

Asthma Zones

These forms are to be completed for a child with asthma. The top portion of the Asthma Action Plan is to be completed by the parent. The lower portion is to be fill out, along with the Asthma Zones form, by your child's physician. 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 asthma.

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

The nurse will return calls periodically during the summer.