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General HealthWashington State form used by parent/guardian to report immunization information for their student. See Washington State requirements for school attendance. Some students (e.g., kindergarten, 6th grade) may need to complete the immunization requirements after registration and before the start of school.Exemptions require both parent/guardian and health-care provider's signature except for certain religious exemptions.Information provided by the parent/guardian alerting the school nurse to health issues. This form may be requested by the school each school year in order to keep current with your child's health information.Gives Steilacoom Historical School District and health care provider, hospital, or clinic permission to exchange information about a studentMedicationState or federal law requires that a form must be completed and signed by both parent/guardian and a licensed health care provider with prescriptive authority for ALL medications to be given at school, including over-the-counter (OTC) medications. This form needs to be renewed at the beginning of each year.Medication at School (Form E)Life-Threatening Health ConditionsWashington State law requires that when there is a student with a known life-threatening condition schools must be prepared for a life-threatening event on the day the student starts school. This would include the necessary forms from the health care provider as well as needed medications. These documents need to provide current information and should be prepared after July 1 for the following school year.Epi Pen Request and Treatment Plan (Form D)Asthma Medication and Treatment Plan (Form C)Seizure Action Plan (Form B)Diet Prescription for Meals at SchoolHealth-care provider must complete and sign that the student needs a special school meals prepared or served because of the student's disability or chronic medical condition.Students with DiabetesPlease call the Lead Nurse, Stephanie Manley (253-583-7249) to discuss the needs of your student. These documents need to provide current information and should be prepared after July 1 for the following school year.Health Care Provider Orders (Form A)
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Health Services Coordinator
Gudrun Sullivan
253.983.2238
Fax:253.582.9274
Lead RN
Stephanie Manley, RN, BSN
253.583.7249
Anderson Island
Dana Ballou
253.884.4901
Cherrydale
Marilyn Langshaw, RN
253.983.2506
Chloe Clark
Emily Harlee, LPN
253.583.7105
Saltars Point
Brianne Giovannini, LPN
253.983.2606
Pioneer Middle School
Andrea Nicolet, LPN
253.583.7208
Steilacoom High School
Toni Kemp, LPN
253.983.2338