Forms
Please note - there are 2 versions of each School Nursing Form:
- Sample PDF - shows you an example of a complete School Nursing Form for a fictitious school district. The material on the School-Nursing.org website is demonstration only and meant only to generate ideas and discussion among school nurses. You must consult with your state and school district before using any material found on this website!
- Editable Microsoft Word Template - is for you to download and adapt to suit your professional needs. Remember to check with your state and school district before using any material found on this website!
Epi-Pen Prescriber's Order Form (Sample PDF)- 70kb)
Epi-Pen Prescriber's Order Form (Editable MS Word Template)
Epi-Pen Parental Consent Form (Sample PDF - 66kb)
Epi-Pen Parental Consent Form (Editable MS Word Template)
Medication Prescriber's Order Form (Sample PDF - 85kb)
Medication Prescriber's Order Form (Editable MS Word Template)
Medication Parental Consent Form (Sample PDF - 91kb)
Medication Parental Consent Form (Editable MS Word Template)
Parent Notification of Student Nurse's Office Visit (Sample PDF - 17kb)
Parent Notification of Student Nurse's Office Visit (Editable MS Word Template)
Student Medical History (PDF-51kb)
Seizure Questionnaire (PDF-49kb)
Student Health Log (PFD-30kb)
The policies, procedures, care plans, etc., are samples meant only to generate ideas and discussion among school nurses. Remember that laws, policies, and procedures vary from state to state and from school district to district; therefore, before you implement any policy, procedure, care plan, etc., you must independently verify that it is in compliance with your state and school district's laws, practice acts, rules, regulations, policies, and procedures. Read School-Nursing.org’s full disclaimer.
*In order to view Portable Document Format (PDF) files you need Adobe Reader. Click here to download Adobe Reader for free.