• Health
    Health Services - Forms
     
    Physical Exam Form (PDF)
    Students entering school in Kindergarten or grade 1, grade 6 and grade 11 are required by state law to have a physical examination. Students who have entered school from other states or countries or do not have a physical examination on file for those grades are also required to have a physical exam.

    Parents are encouraged to obtain the physical examination from their private health care provider and submit a copy to the school nurse. Your private health care provider can provide immunizations and any medical care that your child may require. Students in grade 5 and 10 can submit a copy of their physical examination and it will count as the required examination in grade 6 or grade 11.
     
    Dental Exam Form (PDF)
    Dental examinations are required for students entering school in grades K or 1, grade 3 and grade 7. For your child’s dental health and follow up care, your private dentist is the best person to perform this examination. If your child has seen your dentist, please ask your dentist to complete the Private Dental Form and return it to the school nurse. If you prefer, the school district dentist can do the examination at no cost to you. The school dentist does not provide preventative or restorative care. The parent must contact their own dentist for this follow-up care.
     
    Mobile Dentists: The Mobile Dentists visit our schools approximately every six months to provide preventative and restorative care to students whose parents have completed the permission form. The services provided include a complete dental exam, cleaning, fluoride treatment, X rays, dental sealants, and restorative care such as fillings. The Mobile Dentists can provide preventative care to students who do not have dental insurance if the parents have completed the Grant Form.
     
    Medication Order Form (PDF)
    Parents are required to submit this form completed by the private health care provider and signed by the parent before any medication, prescription or over-the-counter (such as Tylenol or Motrin), will be given to their child at school. The medication order form must be submitted whenever there is a change in medication dosage as well as at the beginning of each school year.

    NOTE: In addition to this form, if not previously completed, the Release and Indemnity Agreement form must be notarized and returned to the school nurse. Parents can print a copy here or obtain a copy from the school nurse at their child’s school or at the District Administration building, where the notarization can be done for free. Or parents can take the form to a local notary, who will charge a fee for notarization. The Release and Indemnity Agreement is valid for the child’s entire Erie Public School career.

    All medication must be in a properly labeled pharmacy supplied bottle with the child’s name and current prescription information on the label and accompanied by the proper medication order form and Release and Indemnity if not previously submitted.  
     
    Asthma and EpiPen Medication Self-Administration Forms and Procedures (PDF)
     
    Students may carry and self-administer inhalers and EpiPens if their private health care provider, parents, school administrator and school nurse sign this form.  Students must be able to follow the procedure and must be responsible to ensure that other students do not have access to their medications. The Self-Administration medication order form must be submitted whenever there is a change in medication dosage as well as at the beginning of each school year.

    NOTE: In addition to this form, if not previously completed, the Release and Indemnity Agreement form must be notarized and returned to the school nurse. Parents can print a copy here or obtain a copy from the school nurse at their child’s school or at the District Administration building, where the notarization can be done for free. Or parents can take the form to a local notary, who will charge a fee for notarization. The Release and Indemnity Agreement is valid for the child’s entire Erie Public School career.
     
    Special Medical Condition Plans (Download Below)
    Parents of students who have a special medical condition should submit the proper plan to the school nurse so that their child’s care can be coordinated and a plan will be in place in the case of symptoms that require care:
    Medical Treatments at School Policy and Authorizations (PDF) 
    Parents of students who require medical treatments during the school day must complete these forms with the child’s private health care provider so that treatments can be given during school. Please contact the school nurse at your child’s school to plan for this care.
     
     Standing Order Parent Permission Slip (PDF)
     
    Release and Indemnity Agreement (PDF)
    The Release and Indemnity Agreement must be completed by the parent and notarized before any medication can be given in an Erie Public School. This form is valid for the child’s entire school career in Erie Public Schools. Parents can take the form to the Erie School District Administration Building at 148 West 21st Street (this is free of charge). Parents must bring proper identification, like a driver’s license or other photo ID card.