Grades PK-5 Universal Health Record
To be completed by a physician. A current immunization schedule must also be attached to this document.
Grades 6-12 Physical Exam Form
To be completed by a physician. A current immunization schedule must also be attached to this document. This needs to be sent to RHS school nurse Laurie Roche PRIOR to starting any of the Phases (REQUIRED for ALL ATHLETES).
Medical Concerns Form
Complete this fillable form to alert the nurse of any pertinent current or previous health issues regarding your child.
Opioid Face Sheet & Sign-Off Sheet
To be completed and signed by parent and student.
Grades 6-12 Only Self-Administration Form
This fillable form may only be used for students that have express permission from their physician and have been trained to administer their medication, such as an Epi-Pen and Inhaler. Students in Tisdale and Hubbard Schools are never permitted to self-administer medication.
for Daily (As Needed) This fillable form is used to give authorization to the nurse to administer both prescription and non-prescription medications, both daily and "as needed".
This fillable form is used to give authorization to the nurse to administer medication for asthma.
This fillable form is used for students that may require the use of an EPI-PEN, AUVI-Q, or Benedryl during the school day.
This fillable form is used for students who have a diabetic condition they are being treated for during the school day.