In order to reduce the amount of students and reduce exposure to COVID-19, DO NOT SEND STUDENTS directly to nurse's office, please complete this form and the nurse will call for them, unless a true emergency (broken bone, seizure etc)
STUDENT NAME (last name, first name)
Emergency? (ACTIVE SEIZURE, LIFE THREATENING ALLERGIC REACTION, SIGNIFICANT PHYSICAL INJURY, STUDENT PASSED OUT,ETC.)
Yes (PAGE THE OFFICE AND STATE THE NATURE OF THE EMERGENCY)
Reason for visit: Check all that Apply
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
**OTHER- PLEASE LIST THE REASON BELOW
**FOR OTHER REASON-Brief description for need of nurse visit
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