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Our new websites have launched!

Staff is extremely excited to introduce a fresh new web browsing experience for its families, students and visitors. As you visit sites, you will find that generic information is listed on school homepages. As staff return to the office in July, information specific to school sites will be updated. Department webmasters are feverishly working to appropriately link and build pages. Please remember that this is a work in progress and edits are coming or underway. We greatly appreciate your patience as we prepare for the upcoming school year!

16 days ago

Chino Valley Unified School District

Student Achievement - Safe Schools - Positive School Climate

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  1. Departments
  2. Curriculum, Instruction, Innovation, and Support (CIIS)
  3. Health Services
  4. Health Services Forms

Health Services Forms

Health Services Forms

Please contact the school site health office or the Health Services Department office for any student health related questions or concerns.  (909) 628-1202 X8918

GENERAL MEDICATION

Medication Administration Form

ADRENAL INSUFFICIENCY

Cover Letter for Adrenal Insufficiency

Adrenal Insufficiency Health History

Medication Administration Forom

ASTHMA (WITH INHALER)

Cover Letter for Asthma With Inhaler

Asthma Health History

Asthma Action Plan

Medication Administration Form

ASTHMA (WITH NEBULIZER)

Cover Letter for Asthma With Nebulizer

Modified PE Form

Medication Administration Form

Asthma Health History

Asthma Action Plan

CARDIAC

Heart Condition Health History

Heart Condition Health History - Spanish

Modified PE Form

DIABETES

Cover Letter for Diabetes

Diabetes Supplies Provided by Parent

Diabetes Management Plan

Diabetic Medication Administration Form

Diabetic Health History Form

FOOD ALLERGIES

Food Allergy Cover Letter

Food Allergy Action Plan

Food Allergy Health History

Medication Administration Form

Medical Statement to Request Special Meals and/or Accommodations (Optional)

NON-FOOD ALLERGY

Non-Food Allergy Cover Letter

Non-Food Allergy Action Plan

Non-Food Allergy Health History Form

Medication Administration Form

SEIZURES (NO MEDICATION AT SCHOOL)

Seizure Disorder Health History

Seizure Action Plan

Permission To Release and Request Confidential Information

SEIZURES (EMERGENCY SEIZURE MEDICATION)

Physician's Authorization for Administration of Emergency Seizure Medication

Cover Letter for Emergency Seizure Medication

Seizure Disorder Health History

Seizure Action Plan

SEIZURES (WITH VNS)

Cover Letter for Seizures with VNS

Physician's Authorization for Use of VNS

Seizure Disorder Health History

Seizure Action Plan

ORAL HEALTH

Oral Health Assessment Letter - English

Oral Health Assessment Form - English

Oral Health Assessment Waiver Form - English

Oral Health Assessment Letter - Spanish

Oral Health Assessment Form - Spanish

Oral Health Assessment Waiver Form - Spanish

Oral Health Assessment Letter - Chinese

Oral Health Assessment Form - Chinese

Oral Health Assessment Waiver Form - Chinese

Please contact your School Nurse with any specific concerns or questions.