Get Fairfax Homebound Form

Filling out the Fairfax Homebound Form online is a straightforward process designed to help students who are unable to attend school due to health issues. This guide provides clear steps to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the Homebound Form online.

1. Press the ‘Get Form’ button to access the form and open it in your document editor.
2. Enter the name of the student in the designated field. Ensure that the full name is written clearly.
3. In the next section, input the name of the school the student attends, followed by the current grade level.
4. Provide a detailed description of the nature and extent of the student's illness in the text box provided. Be as specific as possible to help the reviewing authority understand the situation.
5. Record the date of examination or diagnosis of the illness in the appropriate field.
6. Indicate whether the student is confined at home or in a health care facility by selecting the appropriate box (Yes or No).
7. Answer whether the illness or treatment is intermittent by selecting Yes or No. This pertains to conditions like sickle cell anemia or chemotherapy.
8. Determine if accommodations could allow the child to attend school, and if so, list the specific accommodations required.
9. Enter the estimated date of return to school in the provided field.
10. Explain any ongoing treatment or therapy being provided, ensuring to include all relevant details.
11. Specify the frequency of treatment in the designated section.
12. Have the licensed physician, clinical psychologist, or nurse practitioner sign and date the form. They should also print their name and provide their contact information.
13. Complete the section for the parent/guardian or eligible student by entering their name, phone numbers, and address.
14. Check the acknowledgment and release section, signing and dating it to authorize the release of medical information needed for processing.
15. After confirming that all fields are completed correctly, save the changes, then download, print, or share the form as needed.

Start completing your Fairfax Homebound Form online now to ensure timely processing.