NPS Health Information Form 2025-2026
Health form to be filled out every school year for each student.
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Email:  *
School Year* *
Student's First Name: *
Student's Last Name: *
Student's grade for the 2025-2026 school year. *
Physician Name and Clinic *
Physician Phone Number *
List any daily medications and use for the drug: *
Will your student have any medications to be taken at school? If yes, please list them. (If your student takes medication at school, please fill out the Medication Administration form found on the NPS website. If it is a prescription medication it needs to be signed by student's provider and legal guardian. *
I authorize Linsey Naastad and all our medication trained individuals to administer the following over the counter medications; including: Ibuprofen, Tylenol, Hydrocortisone cream, Calcium Carbonate (Tums), Triple Antibiotic cream,  Menthol topical/Icy Hot, cough drops, and Refresh eyedrops to my student while at school. 
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Are there any OTC medications your child cannot have? If yes, please answer, if no please type N/A.
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Does your student have any allergies? If the answer is yes, please list the allergies and interventions that may need to be done at the school. If you need an emergency care plan for an allergy please contact the school nurse directly. Please note if your child is prescribed an EpiPen and/or inhaler, you are required to supply the school with one. If you do not, you will be required to sign a refusal letter.
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By typing your name below you are authorizing that the above information is accurate and correct. 
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