Health Office » Forms & Downloads

Forms & Downloads

The files below contain the most commonly used health forms for school. Please print the forms you need, complete and sign forms and turn them in to the Hart health office. Forms must be updated and re-submitted at the start of each school year.
 
Contract to Carry Life-Sustaining Medications on Campus
This form must be filled out and signed by a parent and/or guardian, the student and the prescribing physician. The completed form is needed if your child needs any form of prescription medication while at school, such as an inhaler, EpiPen, glucagon, insulin or other prescribed medications.
 
Food Allergy Action Plan
This form must be completed and signed by a parent and/or guardian and the child's physician. This form includes detailed information regarding your child's allergy, including symptoms, dosage of medication needed to offset an allergic reaction and emergency phone numbers. 
 
Prescription or Over-the-Counter Medication Consent Form
This form must be completed and signed by a parent and/or guardian and the child's physician. The completed form is needed if your child needs to take any prescription or over-the-counter medications while on campus.

Inhalers on Campus
Students who carry inhalers must submit one form (see below) in order to carry their inhalers on campus:
  • Contract to Carry Life-Sustaining Meds on Campus
NOTE: Forms marked with EDIT may be completed using your computer. You will not be able to save the completed form (unless you have the correct Adobe program), so hit print and wait for completed form to print before closing the file.