School Health Services - Forms
The school health forms page includes sample letters, documentation of practice or interaction, care plans and more. This site will only be successful if you contribute. I ask that if you use one of the forms and modify it (more than personalizing for your district) to please send me a copy so others can benefit from your work. Please send submissions as WORD documents if possible to lstahlnecker@esd123.org.
If you discover links that don't work, please contact us at lstahlnecker@esd123.org.
Administrative |
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Health Room
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Confidentiality
Consent
Nurses
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Birth Control |
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Policy and/or procedures |
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Condition-Specific Forms - Includes Assessment tools, Care Plans and Evaluation tools
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Generic
Allergies
Anaphylaxis
Asthma & Respiratory
Dental
Diabetes
Eye
Gastro-Intestinal
Head Injury
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Heart & Blood Disease
HIV/Aids
Life threatening conditions
Pediculosis
Scabies
Scoliosis
Seizures
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Correspondence
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Appointment Letters
Growth and Development
Transitions
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Licensed Health Care Provider
Parent Letters
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Immunization/Infectious disease |
DOH Immunization Page
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Medication Administration |
Medication authorization
Need for refill
PRN medication used
Other Letters
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Assessment
Medication logs
End of year letter
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Migrant |
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Schedules |
Kennewick
Walla Walla
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Pasco
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Disclaimer: Documents or links on this page are not intended to endorse any particular products, services, or information sources, but rather to provide examples which school nurses in Washington have found to be useful. Presence on this page does not imply endorsement by this or any agency or organization.
Contact Information
Leslie Stahlnecker
School Health Services Administrator
lstahlnecker@esd123.org
509.544.5715 - phone
509.302.5721 - cell
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