Health Office Information and Forms

Communicable disease information 

Diastat Policy

Allergen Management Policy
 

Medical Clearance Form

 

CTC ACADEMY

For the health and safety of your child, health forms are required to be completed annually.

Each form is attached as a PDF to be opened in Adobe Reader which is installed on most devices and computers. Once the PDF file is opened, click on Fill & sign (located to the right of screen). When you have filled out all your information, you can save the form and email back to your CTC campus nurse.

Please note that ALL students are required to submit the following forms:

  • Emergency Contact Form
  • Health History Form
  • Communication permission form
  • Therapy Participation form ****requires physician completion

These forms are completed by the parents and do not require a physician’s signature (with the exception of the Therapy Participation form).

Please also submit a copy of your child’s immunization record.

The following forms are to be completed only if applicable to your child. These forms need to be completed and signed by a Physician and signed by a parent/guardian:

It is recommended that you email these forms to your child’s healthcare providers. They may be able to complete the PDF forms online and email back to you. You can forward the completed forms in an email to the CTC campus nurse

  • Seizure Action Plan
  • Asthma Action Plan
  • Allergy Action Plan
  • G-tube form (for G-tube feeding at school)
  • Medication Administration forms (only if medications are to be administered DAILY at school). If you would like your child to have as needed orders (for example Acetaminophen or Ibuprofen), please contact your CTC campus nurse

If your child has a Private Duty Nurse, please forward copies of the Care Plan from the nursing agency to be kept on file in the Campus Health Office.

Policy Acknowledgement Parent Signature Form

Asthma Action Plan

Communication Permission Form

Emergency Contact Information

Allergy Action Plan

G-Tube Form

Health History Form

Medical Provider Form

Animal Encounter Permission Slip

Seizure Action Plan

Universal Child Health Record

Medication Administration Form

Parent Portal Instructions Health Packet

Therapy Participation Form