Medical Forms
Medications
Medications are given by the health aide. Prescription medications must be in the pharmacy container. A medication form, available in the office, must be completed and signed by a parent or guardian before we can administer any medications to the child.
Emergency Contact Information
Infinite Campus is our link with you! You are responsible to update your info — especially phone numbers for home and place of employment. This is to protect your child in case of emergency. Police or emergency medical services will be contacted when a child cannot be sent home and the parent or emergency contact cannot be reached.
School Health Office
If child has a temperature of 100 degrees or more, or if illness symptoms persist, children are sent home from school. The school health office provides first aid. We are not able to treat or provide care for very ill children.
Medical Forms in Jeffco
Families must complete the required forms and have them signed by their healthcare provider if their student has a condition that requires the administration of any medication during the school day.
To fill out any of the forms below:
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Click on the form link.
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Download the form.
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Print the form.
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Fill out the form.
Medication Forms
Families must provide a Medication Agreement form, completed and signed by their healthcare provider if their student has a condition that requires the administration of any medication during the school day. This includes over-the-counter and prescription medications.
Families will provide medication in the original packaged or prescription container that has not expired with the signed medication form below. Once received, a nurse may delegate administration of a prescription or over-the-counter medication, based on the health care provider's order.
According to Board policy JLC and Colorado Nursing Board Policy #30-04, district nurses must call physicians to verify orders if needed.
Medication agreement form
Medication Agreement (English) Acuerdo de medicación (Spanish) Разрешение на выдачу лекарств (Russian)
Extended field trip medication forms
One of the following forms must be completed for any overnight field trip.
CO State Asthma Care Plan
Students who require an inhaler or medication for asthma need their healthcare provider and families to complete the Colorado Asthma Care Plan and return it to the school health aide with the medication.
This form replaces the medication agreement form. Families of students with asthma or health concerns are encouraged to contact their District Registered Nurse (RN) to follow up regarding care and support at school.
CO State Allergy Care Plan
Many students have potentially life-threatening food allergies. To address this issue and meet state law requirements concerning managing food allergies and anaphylaxis among students, the Board has established Policy JLCDA. This policy specifies details about a health care plan, reasonable accommodations, access to emergency medications and staff training.
Families, the school administrator, and the District RN will develop a health plan using the Colorado Allergy and Anaphylaxis Care Plan, which you can have your care provider complete and return to the school. This form replaces the above medication agreement form.
CO State Seizure Care Plan
In 2021, the Colorado General Assembly passed HB-21-113 to prioritize school safety for students who have a seizure disorder, including epilepsy. This bill addresses strategic resources for kindergarten through 12th-grade schools to provide a safer environment for these students, including school personnel training, individualized seizure action plans and seizure care guidelines.
Your District RN will work with you to develop a health plan using the Colorado Seizure Care Plan which you can have your provider complete and return to the school. This form replaces the above medication agreement form.