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Health Services               Nurses: Download forms for your school Health Forms These forms are posted as PDF documents and they require the free Acrobat Reader to be viewed. Most forms are formatted so you can fill them out online, print them and then be mailed or dropped off at the school or department. Please be aware that due to the limitations of the free Adobe Acrobat Reader software you will be unable to save your changes unless you have a full version of Adobe Acrobat. Health History — Form 301 For all students - preschool, kindergarten, returning, new to ASD, and transfers Physical Examination for School Entry —- Form 318 For kindergarten students PPD Tuberculin Skin Test Consent or Exemption — Form 363 For kindergarten, new to ASD (never enrolled before), and 7th grade Required Immunization Statement for Provisional School Enrollment Student Allergy Anaphylaxis Action Plan Action plan form for students and staff Information Release Forms Authorization for Release of Immunization/TB Records AK Department of Health and Social Services' authorization to release immunization and/or TB records Consent for Release of Information ASD's form authorizing release of health and educational information Medication Related Forms Authorization for Self-Carry/Administration of Medicine at School and After-School Activities — Form 902 Parent permission form allowing for a responsible, trained student to carry and/or self administer prescription labeled medication for asthma, severe allergic (anaphylactic) reaction, or diabetes. Long Term Non-Prescription Medication Request Parent permission form for requesting the district give non-prescription medicine under certain conditions. Long Term Request for Administration of Prescribed Medication — Form 317B This form or a written statement signed and dated by the physician is required for medication prescribed for more than 15 days. Short Term Prescription Medication Request — Form 317C Parent permission form for allowing school personnel to administer health care provider prescribed short-term prescription medicines for a period of time not to exceed fifteen days. Exemption Forms Religious Exemption Use this form to request an exemption from immunizations based on the tenets or practices of a church or religious denomination. Medical Exemption Use this form to request an exemption from immunizations in situations where immunizations would be injurious to the health of the student or other household members.		Health Services Menu Health Services Home About Health Services First Aid Health Forms Immunizations Links

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Anchorage School District 5530 E Northern Lights Blvd Anchorage, Alaska 99504-3135 907-742-4000