School Health Forms

HCS Student Medication Authorization Form and Release
This is a two page form. Both sides must be printed and signed by parent/guardian.
Children's Healthcare of Atlanta Authorization to Release/Obtain Protected Health Information
This consent is necessary for parent/guardian to sign and provide to the Principal/ School Clinic for the purpose of obtaining school related care plans and medical guidance for the care of their child's medical needs while they are in school or attending school sponsored events or activities (i.e. field trips, after-school care, sports, etc.)
Allergy Action Plan
Asthma Action Plan
Individual Health Plan
Seizure Action Plan
Written Authorization for Self Administration of Medications
This form is mandatory for students to be able to carry their Asthma Inhalers, Diastat, Intranasal Versed, Epi-Pen, or Diabetes supplies.

A physician must complete and sign this form.

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