Health Information

THE FOLLOWING FORMS MUST BE ON FILE PRIOR TO THE START OF THE SCHOOL YEAR!

EN ESPAÑOL
Formularios de salud requeridos
Certificado de examen dental
Certificado de examen de la vista

PRESCHOOL

• Certificate of Dental Screening (Recommended, not required)

• Immunization Record

• Student Physical Form

KINDERGARTEN/NEW 1ST - 8TH GRADE STUDENTS

• Certificate of Dental Screening

• Immunization Record

• Student Physical Form

• Vision Screening

3RD GRADE

• Vision Screening

4TH GRADE

• Student Physical Form

7TH GRADE

• Student Physical Form

• Updated Immunization Record

ATHLETICS

• Athletic Pre-Participation Physical (Grades 5-8)

• Concussion Form (Grades 7-8)

OTHER FORMS

• Diet Modification Request

• Immunization Exemption Form - Medical

• Immunization Exemption Form - Religious

• Medication Authorization Form

• Self-Administration of Asthma Form

If you have any questions, please email our school nurse, Joy Nobles at [email protected]

Health Care Plans

The Iowa Administrative Code 281–41.23(281) states the definition of “individual health plan is the confidential, written, preplanned and ongoing special health service in the education program. It includes assessment, planning, implementation, documentation, evaluation, and an emergency plan. The plan is updated as needed and at least annually. Licensed health personnel develops this written plan with the education team.” The Administrative Code further states before the provision of special health services a written individual health plan is on file [IAC 281–41.23(1)(b)(4)].

Health Forms

• Click Here for Health Requirements
• Click Here for Spanish Translated
• Click Here for Dental Services in Polk County
• Click Here for the Dental Screening form
• Click Here for Student Physical Form
• Click Here for Clinics in the Des Moines Area