216 Aspen Ave SE
PO Box 160
Menahga MN 56464
PHONE
218.564.4141
FAX
District Office/HS: 218-564-5401
MS/ES: 218-564-4502
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 Health Office Forms - Printable File Type View File Download File
Allergy and Anaphylaxis Emergency Plan
Physician and parent/guardian signature required. Please complete this form and submit to the Health Office prior to the first day of school. An updated plan is required each school year.
.pdf
Asthma Action Plan
Physician and parent/guardian signature required. Please complete this form and submit to the Health Office prior to the first day of school. An updated plan is required each school year.
*Student must demonstrate appropriate use of rescue inhaler to School Nurse if planning on self-carrying medication.
*A metered-dose inhaler (MDI) should be used with a spacer to get a dose of medicine into your child's lungs.
.pdf
Authorization for Administration of Medication
Physician and parent/guardian signature required. Please complete this form and submit to the Health Office prior to the first day of school, or as needed for new medications or changes in medications.
An updated plan is required each school year.
*Required for ALL prescription medications grades PreK-12, and ALL over-the-counter medications grades PreK-5
.pdf
Diabetes Medical Management Plan
Physician and parent/guardian signature required. Please complete this form and submit to the Health Office prior to the first day of school. An updated plan is required each school year.
.pdf
Minnesota Immunization Form
Updated Immunizations Required for students entering:
Pre Kindergarten / Kindergarten / 7th Grade / 12th Grade (Starting 2021-2020 School Year)
*Non-Medical Exemptions must be completed for students entering Kindergarten and again for those entering 7th Grade.
*History of Chickenpox (Varicella) Disease after September 1, 2010 must be confirmed by a licensed physician, nurse practitioner, or physician assistant.
.pdf
Special Diet Statement
Physician and parent/guardian signature required. Please complete this form and submit to the Health Office. You will need to submit this form only ONCE for each student. Please only submit additional forms if changes/updates are necessary.
.pdf
Seizure Action Plan
Physician and parent/guardian signature required. Please complete this form and submit to the Health Office prior to the first day of school. An updated plan is required each school year.
.pdf