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Home / Government/ Health / Public Health / School Health / School Health Forms

School Health Forms

School Entry

  • Commonwealth of Virginia School Entrance Health Form
  • Tuberculosis Risk Assessment(PDF, 478KB)

Health Conditions

Adrenal Insufficiency

  • Adrenal Insufficiency Action Plan - Medication Authorization Form(PDF, 164KB)

Allergies

  • Allergy Care Plan – Physician’s Order
    • Physician Order/Severe Allergy Action Plan – English(DOCX, 46KB)
    • Physician Order/Severe Allergy Action Plan – Spanish(DOCX, 42KB)

Asthma

  • Asthma Action Care Plan  

Concussion

  • Acute Concussion Evaluation Plan

Diabetes

  • ADA Diabetes Medical Management Plan (DMMP)

Seizures

  • Seizure Action Plan

Medication Authorization (including over-the-counter)

  • Medication Authorization Form - English(PDF, 193KB)
  • Medication Authorization Form - English and Amharic(PDF, 282KB)
  • Medication Authorization Form - English and Arabic(PDF, 340KB)
  • Medication Authorization Form - English and Bengali(PDF, 355KB)
  • Medication Authorization Form - English and Mongolian(PDF, 209KB)
  • Medication Authorization Form - English and Spanish(PDF, 207KB)

Sports

  • Sports Physical Examination from Virginia High School League
 
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Ellen M. Bozman Government Center
2100 Clarendon Blvd., Arlington, VA 22201 View Map

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