Get Clinic Pass - Broward County Public Schools Coordinated Student

Filling out the Clinic Pass for Broward County Public Schools is a crucial step in documenting student health visits. This guide provides clear and detailed instructions to users, ensuring a smooth completion of the form.

Follow the steps to effectively fill out the Clinic Pass form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date at the top of the form where indicated. This helps establish the timeline of the student’s visit.
3. Fill in the student's name in the 'Student' section, ensuring to include their last and first names.
4. Specify the name of the teacher in the designated field, and mark the student's gender by selecting either 'M' for male or 'F' for female.
5. Complete the date of birth section, providing the student's full birth date.
6. Indicate the student’s grade level in the corresponding field.
7. Enter contact phone numbers in the provided fields, ensuring to note at least one contact number.
8. Describe the reason for the referral clearly in the section provided, detailing the student's health issue.
9. Fill in who referred the student to the clinic and the time of referral (AM/PM).
10. In the 'Clinic Use Only' section, record the time the student arrived at the clinic.
11. Select the nature of the complaint from the given options, marking the appropriate boxes.
12. Document any actions taken regarding the student's care, such as temperature checks or treatments provided.
13. Indicate whether the parent or guardian has been notified, including the time of notification.
14. Clarify the disposition of the student after their visit, selecting from the provided options.
15. Ensure the teacher has been notified regarding the student’s visit through the designated section.
16. Record any additional comments or notes that may be relevant to the visit in the comments section.
17. Enter the name of the clinic staff member who handled the action.
18. Finalize the form by saving your changes, and then download, print, or share the form as needed.

Complete your Clinic Pass online to ensure your student’s health information is documented and accessible.