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Health Form

Forms

Required

PARENT/GUARDIAN completing form:required
First Name
Last Name
Do any of your children have significant health conditions (asthma, seizures, diabetes, allergies, etc.), which should be should be known by the school?required
If you would like to discuss any specific concerns regarding your child's health with a school nurse, please leave a message with the school administrative assistants at 605-874-2161.

Important Notices

• Immunization Records:

The South Dakota Immunization Information System (SDIIS) is an automated system to record vaccination records. SDIIS gives you access to your child’s immunization record from any participating South Dakota heath care provider. Immunization records received by the school will be entered into the registry. If you choose not to share your child’s record, please contact the school within two weeks to request a refusal form.
• Emergency:

In the event physicians, parents, or designated emergency contacts cannot be reached, the school officials are hereby authorized to take whatever action is deemed necessary in their judgment, for the health of aforesaid child. Responsibility for payment of ambulance, physician, and/or hospital expenses is that of the parent/guardian. I give permission to medical personnel to provide emergency health care.
• Release of Information/Notice of Privacy:

In order to provide a safe and healthy environment for your child, this health information will be shared with appropriate school staff. If you would like to review the Notice of Privacy Practices, please refer to: https://www.sanfordhealth.org/privacy-of-health
Self-Administration of Medication:
For Students in Middle and High School Only
 
• Medication Administration: Students in grades 6-12 have the option to bring one day’s dose of medication (ex. Tylenol) to school and self-administer as needed. If the medication is a controlled substance or if you request a school personnel to assist with medication administration, please discuss with a school nurse in order to complete an additional form.
 
• Self-administration of medication (unsupervised): I authorize my child to bring one day’s dose of medication to school and self-administer the medication (if not a controlled substance). I understand self-management privileges will be lost if he/she does not use the medication properly or responsibly. The Deuel School District and personnel will not be held liable. 
Parent/Guardian Signature:required
Must contain a date in MM/DD/YYYY format
Terms of Service

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