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Get KS HKS Severe Allergies & Anaphylaxis – Health Intake Form

L orders, along with the health intake below, assist the school nurse in developing an Individual Healthcare Plan for the student. Student s Name: DOB: / / Grade: Today s Date: / / Parent/Guardian 1: Contact Information: Parent/Guardian 2: Contact Information: Name of physician treating student s allergies:.

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Hoarseness rating
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