PWCS Health Forms
Below are downloadable forms. If your child has a health concern that will/may need to be addressed during school hours, please complete the appropriate forms. As a reminder, Health Treatment Plans (HTPs) need to be re-done annually (by both parent and health care provider) and should be brought to the clinic with any medications prior to the beginning of each school year. Students may not bring medication to or from school at any time without proper parental and physician consent on file in the school clinic (updated annually).
- School Entrance Health Form (PDF)-- Compete this if your child is new to PWCS. Also, be sure to get all his/her immunizations up-to-date and bring a record. A tuberculosis screening may be required, and your health care provider can assist you with this if needed.
- Medication Administration Authorization Form (PDF)-- Complete if your child requires a medication at school. If you have questions, please consult with school nurse.
- Asthma Action Plan Part 1- Virginia Asthma Action Plan (PDF)--Complete these 2 parts if your child has asthma.
- Asthma Action Plan Part 2--Health Treatment Plan Authorization (PDF)
- Allergy Action Plan Part 1- Part 6 (PDF)-- Complete all 6 parts if your child has a life-threatening allergy.
- Seizure Action Plan Part 1 – Part 2 (PDF)-- Complete these 2 parts if your child has a seizure disorder.
- Diabetes Medical Management Plan (PDF)-- Complete this DMMP if your child has diabetes and contact the School Nurse prior to the child coming to school to go over the plan.
- Diabetes - Students with Insulin Pump and/or Continuous Glucose Monitors usage at school guidance (PDF)