Forms
General Forms
Annual Student Health Information
Every student should have an updated and completed Student Health Information form on file with the school nurse EACH year.
Permission to Administer Medicine
Complete this form and bring with your student's medication to the School Nurse or designated staff member. Reminder: students may not transport medication to school.
Authorization to Carry a Prescription
Have your physician or provider complete this form to allow your student to have an epi pen, inhaler, or diabetic supplies on their person.
Special Dietary Needs Form
Complete this form for food sensitivities & allergies.
Medical Policy/Parent Letter
The Health Services letter details and summarizes the health policies for Effingham County Schools. You can learn more about our department and the services it offers.
Religious Exemption Form for Immunizations
Required documentation for immunization waiver. Must be notarized.
Children's Dental Health
Help A Child Smile Parent Letter & Form
Form 4400: Certificate of Scoliosis Screening
Required for students entering 6th and 8th grade.
Action Plans
Anaphylaxis Action Plan
For life threatening allergic reaction; accompanies an epinephrine injection prescription (Epi Pen, Epi Pen Jr, AuviQ, etc). Must be completed and signed by your child's physician or provider.
Asthma Action Plan
For the chronic condition of asthma; accompanies an emergency inhaler (albuterol, etc). Must be completed and signed by your child's physician or provider.
Diabetes Action Plan
Required for diabetic students. Completed by your child's physician or provider. Gives guidance on the management of the diabetic student while in school.
Food Allergy Action Plan
For students with allergies to food. May accompany an anaphylaxis action plan as well. Completed by your child's physician or medical provider.
Seizure Action Plan
For students with seizures; accompanies emergency medications kept in the clinic. Completed by your child's physician or medical provider.