School Health Services Medical Forms
Forms for Doctors’ Physicals
- School Entrance Health Form: give to your school office at registration
- VHSL Athletic Participation Physical Form: give to your coach or the school office
Forms for Administering Medicine at School
Medications can be given at school if parent has signed a permission form and brought in the student’s medication. School nurses will also get confirmation from the student’s physician before giving the medication, whether prescription or non-prescription.
- Charlottesville High School: return to school nurse
- Walker or Buford: return to school nurse
- Elementary Schools: return to school nurse
Release of Information Forms
These forms allow release of confidential medical information on a student between the school and the student’s health care provider. It is required that the form be signed by the child’s parent or guardian before medical institutions can provide any information to the school nurse regarding the child’s health or any activity restrictions. Likewise the school nurse cannot contact a health care provider directly on behalf of a student without a signed release form.
- Charlotesville Schools Release of Medical Information: return to school nurse
- UVA Release of Information Form:
- UVA Autorizacion para la Divulgacion de Informacion Medica
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To Learn More
Dr. Kendra King
Director of Student Services and Achievement
1562 Dairy Road
Charlottesville, VA 22903