Medical Forms/Health Info
Please ask the JICHS front office for, or download and print from below, medical forms for your student. Most forms must be signed by a physician.
Allergy and Anaphylaxis Emergency Care Plan and Medication Orders
Confidential Health Information
Non-Medical Immunization Exemption Module
Over-the-Counter Meds Information
Self-Carry for Inhalers and Epipens
Does my student require a medical form?
Your student has asthma. Asthma HCP will need to be completed.
Your student has asthma and will be carrying an inhaler on campus. Asthma Contract to Carry will need to be completed.
Your student has allergies. Allergy Emergency Plan will need to be completed.
Your student has allergies and will have an Epi-pen on campus. Epi-Pen Contract to Carry will need to be completed.
Your student has diabetes. Diabetic HCP will need to be completed.
Student Medication form and Cough Drop Carry Contract will need to be completed.
You would like your student to receive mints or crackers on an as-needed basis from clinic. Student Medication form will need to be completed.
Your student has medical concerns that may need to be addressed during school hours. Confidential Health Information form will need to be completed.
*HCP –Health Care Plan
