Health Forms

School Entrance Requirements:

All preschool, kindergarten, and new to the county students are required to submit a Virginia School Entrance Health (Physical) Form and immunization record completed by a licensed provider prior to the first day of school. School entrance physicals must be completed within one year of entry. This means that for the 2020-2021 school year, physicals must be completed between September 8, 2019 and September 7, 2020. This is in accordance with the Virginia Department of Education school entrance requirements and is a requirement for both in person and virtual schooling within the county. Due to the holiday weekend, these records must be provided to the school nurse by Friday, September 4, 2020 at 4:00 pm in order to begin classes on the first day of school, Tuesday, September 8, 2020. Blank copies of the School Entrance Health form (and other related forms) that can be provided to your child's health care provider are linked below.

Commonwealth of Virginia School Entrance Health Form

Commonwealth of Virginia Minimum Immunization Requirements

Religious Exemption Form

If you need assistance or resources regarding school entrance physicals or immunizations, please contact the school nurse, Michelle Cota, at [email protected]

 

Health Treatment Plans:

Health treatment plans should be completed by the student's physician and delivered to the nurse at the start of each school year. Any accompanying medications must be delivered by the parent in original, unopened packaging with prescription label intact (when applicable) and unexpired. Students are not permitted to transport medications to and from school.

Virginia Asthma Action Plan

Updated Virginia Diabetes Medical Management Plan (DMMP)

Seizure Action Plan

Cancer Care Plan

Authorization for Medication Administration Form

Tube Feeding Treatment Plan

Medical Procedure Treatment Plan

Food Allergy & Anaphylaxis Emergency Care Plan
Request for Administration of Medication for Allergic Reactions
Student Epinephrine Self-Carry Authorization
Severe Allergy Individual Health Care Plan
Student Allergy History Form

Authorization to Implement Health Treatment Plans
(Must accompany ALL PWCS Health Treatment Plans)

Release of Medical Information Authorization