PWCS Health Forms
Below are downloadable forms. If your child has a health concern that will/may need to be addressed during school hours, please complete the appropriate forms. As a reminder, Health Treatment Plans (HTPs) need to be re-done annually (by both parent and health care provider) and should be brought to the clinic with any medications prior to the beginning of each school year. Students may not bring medication to or from school at any time without proper parental and physician written consent on file in the school clinic (updated annually).
School Entrance Health Form (PDF)-- Compete this if your child is new to PWCS. Also, be sure to get all his/her immunizations up-to-date and bring a record. A tuberculosis screening may be required and your health care provider can assist you with this if needed.
Asthma Action Plan Part 1- Virginia Asthma Action Plan (PDF)--Complete these 2 parts if your child has asthma.
Asthma Action Plan Part 2--Health Treatment Plan Authorization (PDF)
Allergy Action Plan Part 1 (PDF)-- Complete these 6 parts if your child has a life-threatening allergy.
Allergy Action Plan Part 2 (PDF)
Allergy Action Plan Part 3 (PDF)
Allergy Action Plan Part 4 (PDF)
Allergy Action Plan Part 5 (PDF)
Allergy Action Plan Part 6 -- Health Treatment Plan Authorization (PDF)
Seizure Action Plan Part 1 (PDF)-- Complete these 2 parts if your child has a seizure disorder.
Seizure Action Plan Part 2-- Health Treatment Plan Authorization (PDF)
Diabetes Medical Management Plan (PDF)-- Complete this DMMP if your child has diabetes and contact the School Nurse prior to the child coming to school to go over the plan.
Diabetes - Students with Insulin Pump and/or Continuous Glucose Monitors usage at school guidance (PDF)
Cancer Action Plan Part 1 (PDF)-- Complete these 2 parts if your child has cancer andcontact the School Nurse prior to the child coming to school to go over the plan.
Cancer Action Plan Part 2--Health Treatment Plan Authorization (PDF)
Immune Compromised Children-- If you child is immune compromised (non-cancer related), no specific forms are needed, but please contact the School Nurse prior to the child coming to school.
Urinary Catheter Action Plan Part 1 (PDF)-- Complete these 2 parts if your child requires urinary catheterization at school andcontact the School Nurse prior to the child coming to school to go over the plan.
Urinary Catheter Action Plan Part 2--Health Treatment Plan Authorization (PDF)
Tube Feeding Action Plan Part 1 (PDF)-- Complete these 2 parts if your child requires tube feeding at school andcontact the School Nurse prior to the child coming to school to go over the plan.
Tube Feeding Action Plan Part 2--Health Treatment Plan Authorization (PDF)
Medical Procedure Action Plan Part 1 (PDF)-- Complete these 2 parts if your child requires a medical procedure (not medication) at school that is not listed above andcontact the School Nurse prior to the child coming to school to go over the plan.
Medical Procedure Action Plan Part 2 --Health Treatment Plan Authorization (PDF)
Medication Administration Authorization Form Part 1 (PDF)-- Complete these 2 parts if your child requires a medication at school that is not listed above (for example an ADHD medication that will be given daily at noon, an antibiotic that needs to be given mid-day for the next ten days, or a pain medication that may be needed due to a recent injury, etc.).
Medication Administration Authorization Part 2 --Health Treatment Plan Authorization (PDF)
Not seeing what you need? Contact me at my work email, [email protected] and I'll help! :) --Holly
PWCS Health Regulations and Other Useful Information
When to keep your child home from school--PWCS exclusion criteria (PDF)
Food and Nutrition--Homepage (PWCS website) Click on "special diets" for ingredient lists, nutritional analysis (including carbohydrate counts), and common food allergy listsfor all food that is served at school.
Lice- Head Lice complete info for parents (Seattle Children's Website)
Lice-Head Lice 101, Information for parents (National Association of School Nurses Website)
Lice- Facts about Head Lice (PWCS Website)
Lice- Prevention and Treatment (PWCS Website)
Lice- Management in the school setting (PWCS Website)
Immunization--Virginia School Requirements (PWCS Website)
Immunization--Recommended Vaccines, Easy to Read Chart ages 0-6 years old (CDC Website)
Immunization- Recommended Vaccines, Easy to Read Chart ages 7-18 years old (CDC Website)
Allergy and Asthma Network (Website)
PWCS Student Health Services Program (Website)
PWCS Regulations and Policies (Website)
Not seeing what you need? Contact me at my work email, [email protected] and I'll help! :) --Holly
Hearing and Visions Screening
Hearing and vision screenings are mandated by the state of Virginia and will be completed for all students in kindergarten, third, seventh, and tenth grades as well as all new students to PWCS . Parents/Guardians will be contacted if a student fails his/her screening.