Forms
The following are a list of medical forms to be completed by a parent/guardian; please note that some forms require a physician's signature. All students who have a medical condition should complete a student individual emergency medical plan. Additional forms are required for special diets (i.e. no pork, soy allergy, etc.), diabetes, siezures, severe allergies, and asthma. Medication forms must be completed on all prescribed and OTC (over-the-counter) medications in order for the nurse to administer the medication to your child. Please note that students are not allowed to carry medications on campus. Exceptions are those who have completed the self carry medication form. Any student found to have medications in their possession will be sent to the nurse's office and a parent or guardian will be notified. Please refer to the student handbook in regards to medications on campus. If you have any questions or concerns please feel free to contact me by email at Kimberly.Reichert@dvusd.org.
Parent Authorization Release of Information
Anaphylaxis-Emergency Plan Requires a physician's signature
Diabetes Requires a physician's signature
Asthma Requires a physician's signature
Medication form Doctor's order (Needed for each prescription medication) Requires a physician's signature
Mar Log (Medication Form )
Bus Rider Form (for students with illness and rides bus. Will be given to bus driver so they are aware of situation) If this is not filled out bus driver will not know of illness.