Get Health History / Permission To Treat Form - Scott County ... - Images Pcmac

The Health History / Permission To Treat Form is an important document that ensures comprehensive care for students by providing essential health information to school health personnel. Properly filling out this form is crucial for effective communication between caregivers and the healthcare team.

Follow the steps to successfully complete the Health History / Permission To Treat Form.

1. Click the ‘Get Form’ button to obtain the Health History / Permission To Treat Form and access it in the editor.
2. Begin by entering the student’s name, birth date, current age, school, and current grade in the respective fields. This information is vital for identification.
3. List the names, phone numbers, emails, and relationships of caregivers in the designated order, ensuring accurate contact points for emergencies.
4. Specify your permissions regarding health decisions by checking the appropriate boxes, allowing designated individuals to make critical choices if you are unreachable.
5. List all medications that the child normally takes, including the name, dosage, frequency, and reasons for administration. This is essential for the school nurse and healthcare team.
6. Add any special measures, directions, or comments that the school healthcare team should be aware of regarding the child’s health status.
7. Indicate anyone with whom you do not want the child's health information shared, selecting from the provided options to restrict information disclosure.
8. Confirm the date of the child’s last medical check-up with their physician.
9. Sign as the primary legal guardian, providing your name and phone number to certify the information provided.
10. If applicable, provide additional details regarding any specialists the child sees, along with their contact information and any health conditions that may affect the school day.
11. Review all entered information for accuracy and clarity before saving, downloading, or printing the form for distribution.

Complete the Health History / Permission To Treat Form online to ensure your child's health needs are met effectively.