Health Forms for CHS Students

Discretionary medication form-Parent or guardian to complete for over-the-counter medications that may be given to your student at school when deemed necessary by the nurse. Included in this form is space for you to list your child’s allergies, health concerns, and current medications. This form is only valid for the current school year and must be done again each fall. Please have your student deliver it directly to the Nurse’s Health Suite in person, or you can send digitally via email. 

Prescription Medication Form-Parent and prescribing provider to complete when a student needs to take a prescription medication during the school day hours. This MUST be completed and returned by the parent/guardian to the school nurse along with the medication in a labeled prescription bottle. Students may not drop the medication off.Completed forms can be hand delivered with medication or submitted digitally via email or faxed by the provider. 

Any student with needs pertaining to asthma while in school, also needsthe form below completed by their provider, to be delivered by a parent along with their inhaler, nebulizer, or other treatments/supplies. 

Medical Procedure Forms-these forms are required to be completed by the prescribing provider and signed by parent/guardian for tube feeding, catheterizations, and other medical procedures completed by the nurse while your student is at school. Please give the nurse a call if this is something your student needs to complete a full health intake for the related condition. This can be submitted electronically via email or fax, or hand delivered by parent with suppliesPLEASE CALL Nurse Kisser prior to dropping off as there are details relating to these procedures that will need to be discussed to provide the best care for your student and their specific needs.

Wellness Center Application and Health history form-This packet should be completed by a parent/guardian for any student who wants to join the wellness center program. It is good for all 4 years the student attends Chesapeake High school and is very beneficial for ALL students. A Nurse practitioner from BCDH is here 2 days per week and can see your student for health concerns that the nurse believes require some sort of follow up or treatment that cannot be addressed in the health suite. Please see ‘The Wellness Center” page (LINKED) for more details. When completed, this can be given to any staff member in the Nurse’s Health Suite. 

Sports Physicals Forms—If you want to play at school at Chesapeake, you must have a completed sports physical every 14 months. You can get it with your primary care doctor, or at an urgent care or minute clinic if you prefer (copays/fees may apply per your insurance). You can also get it done through The Wellness Center (LINKED) if you are a member. Please complete the wellness center application in addition to the sports physical history form. It can be given to the any staff member in the Nurse’s Health Suite.