SPE Nurse E-pass
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)
Timeout (DO NOT ANSWER NURSE USE ONLY)
Student LAST & FIRST NAME
Emergency (send student first then fill out E pass)
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 GIVE DETAIL BELOW)
For other Non COVID-19 related visits please give brief description of problem:
Nurse Notified Parent (DO NOT ANSWER NURSE USE ONLY)
Results (DO NOT ANSWER NURSE USE ONLY)
Send me a copy of my responses.
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