School health needs tool
Helps you find out if we can help you with your physical and vaccination needs for school.
Child’s first name and age
Parent’s first name
Do you need a physical form?
Do you need vaccinations?
Do you know which vaccines are needed?
List vaccines needed
Do you need assistance determining what vaccines your child needs?
Straight Medicaid - Policy #
Medicaid managed care
Child health plus
Insurance from my employer or other parent's employer
I have insurance, not sure which.
Native American/Pacific Islander/Native Alaskan
Optional insurance card numbers to determine what type, please provide all numbers and labels to help us help you.
Send me a copy of my responses.
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