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Health Forms

Medication Administration Consent and Licensed Prescriber Order

All medications — including over-the-counter items such as cough drops — require a physician's order.

 

Physical Examination Form

The Pennsylvania Public School Code Section 1402. Health Services (e) requires that students upon original entry, sixth grade and 11th grade be given a "comprehensive appraisal" of their health. The physical is to be completed within 4 months prior to the start of the school year. 

 

Dental Form

This form may be used by both the mandated and dental hygiene programs as the dental portion of a student's comprehensive health record.​

 

Immunization Exemption Form

Pennsylvania Code §23.84 Exemption from Immunization