Immaculate Heart of Mary School

Skip to main content
Mobile Menu
IHM School and Preschool on 2 Hour Delay TODAY 1/24/19
Nurse's Office » Health Information & Forms

Health Information & Forms

REQUIRED forms for NEW K-8 Students:

Student Medical Record, Copy of Immunization Record & Oral Assessment

(See below for forms)




In order to safely care for your child, we must have a "Request for Medication by School Personnel" form completed for each medication your child receives at school. (These forms for prescription and over-the-counter medication are found below.) Please bring your child's medication, in its original packaging, with the label and expiration date clearly visible, to the front office. If there are any changes in the type of medication, the dosage of the medication, or the time of the dosage, a new form must be filed out or a note from your doctor is required stating those changes. We will be unable to administer medication to your child without completed paperwork. Medication is NOT to be transported by the student.


Prescription medications: The form must be completed and signed by both the Healthcare Provider and parent/guardian. 


Over-the-counter medications: The form must be signed and completed by a parent/guardian.


New medication and paperwork must be provided for each school year. Please pick up your child's medication at the end of the school year. 



Food Allergy or Asthma

Please complete a "Allergy Action Plan" or an "Asthma Action Plan" if your child has been diagnosed with asthma or a food allergy. This will help ensure your child will be cared for safely in the event of an emergency.  (These forms are found below.) Please ensure we have both a healthcare provider and parent/guardian signature on each form.


If your child will be possessing and using their own EpiPen or Inhaler at school, please complete the Asthma Inhaler or Epinephrine (EpiPen) Autoinjector Authorization forms found below. Also, for those students who are authorized to carry their own EpiPens, it is required by law to keep a backup EpiPen in the Health Room. Please be sure to provide the school with a backup EpiPen for your child.