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Health Forms

School nurses and practitioners may use these forms to track individual students' health requirements.

Special Education Forms

Health Screening Form (Word Doc) A document used to state any health concerns  
Instructions for completing the Health Screening Form (PDF)

Special Education Health Evaluation Form (Word Doc)

*Special Education Health Evaluation Guide (Word Doc)

A document used to state any health concerns potentially affecting educational performance of students with health management needs

Guidelines for filling out the special education health evaluation form

Individual Student Medicaid Record (PDF)  A form to document individual student health concerns Medicaid
Individual Student Medication Record (PDF)  A blank form to track when students take medications
Individual Student Health Record (PDF)  A form to track student visits, treatments and parental notifications

General Education Forms

Individual Student Health Plan (IHP)
 *Advanced IHP Template (PDF)

A document that helps plan for students with health management needs
Emergency Plan (EP) (PDF) A document that helps plan for emergencies for students with health management needs
Student Health Progress Notes (PDF) Track a student's progress
Health Communication Record (PDF) A template to record contact information for primary care physician, consulting physician and others

Vision Screening Guidelines (PDF)

Guidelines are from the University of Iowa Department of Ophthalmology Vision Screening (formerly the Iowa Vision Screening Guidelines) also with vision screening recording forms for preschool and school age students
Doctor's Orders for Special Health Services (PDF) Physician orders for special health services

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