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Jefferson Township

Public Schools

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Health Services Forms and Documents

Medications in School

MedicationinSchool.pdf 85.79 KB (Last Modified on May 18, 2016)

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Lice Handbook

Lice Handbook for Parents.pdf 397.83 KB (Last Modified on May 18, 2016)

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Allergy Emergency Action Plan

AllergyEmergencyActionPlan2016 revised.pdf 299.28 KB (Last Modified on November 1, 2016)

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Epinephrine Self Administration Form

Epinephrine self administration Form.pdf 114.74 KB (Last Modified on October 16, 2018)

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Parent Agreement for Student with Life-Threatening Food Allergies

AllergiesParentAgreement.pdf 7.41 KB (Last Modified on May 18, 2016)

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Seating Accommodations for Food Allergy

allergiesseatingaccommodations.pdf 67.87 KB (Last Modified on May 18, 2016)

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Asthma Action Plan

Asthma Treatment Plan.pdf 241.37 KB (Last Modified on October 12, 2017)

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Seizure Action Plan & Questionnaire for Parent of a Student with Seizures

Seizure Action Plan.pdf 195.85 KB (Last Modified on May 18, 2016)

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Medication Permission form

Medication permission form.pdf 207.85 KB (Last Modified on June 13, 2018)

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Over the Counter Medication Permission form

OTC medication permission.pdf 65.95 KB (Last Modified on June 13, 2018)

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PSK Eye Form

PSK Eye Form.pdf 40.75 KB (Last Modified on May 18, 2016)

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Report of Dental Examination

ReportofDentalExam1.pdf 24.65 KB (Last Modified on May 18, 2016)

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Physical Form (School entry Physical Exam Form)

PhysicalFormK8thgrade2016.pdf 133.28 KB (Last Modified on November 1, 2016)

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Physical Form (High School Sports/Band Pre-Participation Physical Exam Form)

NEW STATE PHYSICAL FORM 3-2015.pdf 574.63 KB (Last Modified on September 17, 2020)

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