SHS Nurse Sign-In
Please complete the form. Each field must be completed before you can submit the form.
Student ID #
Reason for Visit - Select from drop down menu
AA. Appointment for Flu Vaccine
C. Appointment for Dental Screening
D. Appointment for Hearing Screening
E. Pediculosis (head lice)
F. Scoliosis Screening
G. Appointment for vision screen
H. 2nd Screening for Vision, Dental, etc.
I. Employee Assessment
J. Acute Illness (headache, stomachache, cold, fever, sore throat, chest pain)
K. Acute Injury (cut, burn, ?broken bone)
L. Blood Pressure
M. Dermatology (SKIN, Bandaid, rash)
N. Substance Abuse
O. Mental Health (anxiety, panic, depression)
T. Pregnancy or Rule out Pregnancy
U. Reproductive (CRAMPS/PADS/TAMPONS)
V. Follow up
X. PRN Med. (medicine on file)
Y. Daily Treatment
Z. Daily Meds
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