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Nurse Forms

CT Blue Form (Physical Assessment):
https://portal.ct.gov/-/media/sde/school-nursing/forms/health_assessment_record.pdf

                                           
Physical Exam


Medication Authorization form:
* one medication per form
* parent/guardian and doctor must sign form
* NO medications can be given in school without a completed medication authorization form
*children can ONLY self carry inhalers and Epi Pens

Medication Authorization Form-- English
Medication Authorization Spanish.docx
         

 

 

medication


Care Plans:
1. FARE Food Allergy English and Spanish.pdf
2. Asthma English and Spanish 0-11 yrs.pdf
3. Asthma English and Spanish 12 yrs +.pdf
4. Seizure Care Plan--English
5. Seizure Care Plan--Spanish

* Nurse can make personalized care plans with student photos as well
                                  

Nursing


HIPAA:
1. HIPAA Blank form for TMS.docx
2. HIPAA Blank form for TMS - Spanish.docx
3. HIPAA Blank form for CCMC students.pdf
4. HIPPA Blank form for CCMC Students - Spanish.pdf
        

 

HIPAA