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Student Medical Information Form (HS)

Please Fill Out The Student Medical Information Form (HS) Below

Simms ISD 19-20 Student Medical Form

This medical information sheet is only good for the stated school year. A new form will be issued at the beginning of each school year.


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Medical Information:













NOTICE TO PARENTS

Part II Medication brought to school by a student or parent will be given by the nurse or a designated staff member. The school is required to have a signed permit on file in the office to administer any medication – prescription or over the counter. It is also required that all medication be in its original container. The following information should be on the label of the prescription or taped to the bottle of over-the-counter medication: *Name of Student *Name of Medication *Amount of Medication * Time Medication is to be given

PERMISSION TO ADMINISTER MEDICATION

Part III I have read the statement in Part II and hereby authorize the school nurse or designated staff member of Simms ISD to administer medications to my child under the stated conditions. Further, I will not hold the school responsible for doses of medication missed when I have not followed the above medication labeling procedure and I will provide any medication that my child will need to take on a regular basis.

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Other Medications

Although the school does not want to make a habit of dispensing medication, we realize that there might be a rare occasion when it is necessary.



ALL CHILDREN WITH A TEMPERATURE WILL NOT BE MEDICATED BUT WILL BE SENT HOME

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List your child’s physician for emergency purposes.

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In case of a minor accident or illness, I hereby authorize a staff member of Simms ISD to administer first aide. In the event I cannot be reached by telephone and there is a serious illness or accident, I hereby authorize a staff member of Simms ISD to seek emergency medical treatment for my child. I also authorize doctors to give named child whatever treatment is necessary for his/her immediate safety or well-being.

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Emergency Contacts:

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