Health Forms (English)

Anaphylaxis Health Care Plan

Anaphylaxis Health Plan.pdf 2.88 MB (Last Modified on March 2, 2023)

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Diabetes Health Care Plan

Diabetic Emergency Health Plan.pdf 938.38 KB (Last Modified on August 5, 2022)

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Seizure Action Plan

Seizure Action Plan.pdf 488.44 KB (Last Modified on March 2, 2023)

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Emergency Care Plan Form 151

Emergency Care Plan English 4.22.pdf 436.44 KB (Last Modified on March 2, 2023)

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Medical Examiner's Statement Form 147-E

Medical-Examiner-Statement-Form147E-English-2022.pdf 338.29 KB (Last Modified on December 1, 2022)

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Medication Authorization Form 157

Medication_Authorization-Form157-English_2022.pdf 293 KB (Last Modified on April 7, 2022)

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Medical Consent Form 156

Medical_Consent_Form_156_-_English_2021.pdf 94.07 KB (Last Modified on June 24, 2021)

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Student Health Inventory Form 143

Student Health Inventory Form English.pdf 93.28 KB (Last Modified on October 5, 2018)

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Tuberculosis Clearance Form 603

TB Clearance Form 603.11.22.pdf 346.22 KB (Last Modified on November 9, 2022)

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Chronic Illness Verification Form (CIVF)

Chronic Illness Fillable Form.pdf 650.71 KB (Last Modified on February 22, 2023)

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Immunization Requirements (starting July 1, 2019)

Updated Immunization Requirements for SMUHSD as of 07_01_2019 English.pdf 333.51 KB (Last Modified on August 15, 2022)

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Health Forms (Spanish)

Plan de salud anafilaxia

ECP-FAAP_Plan_Spanish-05-12.pdf 2.84 MB (Last Modified on August 5, 2022)

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Plan de salud para la diabetes

A-Diabetes.Management.Authorization.Spanish.7.21.pdf 442.1 KB (Last Modified on August 5, 2022)

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Plan de accion para convulsiones

GENERAL SEIZURE ACTION PLAN_SPANISH_2021.pdf 422.24 KB (Last Modified on August 5, 2022)

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Emergencia Médica/Plan De Salud - Form 151

Emergency Care Plan - Spanish Form 151.pdf 347.35 KB (Last Modified on June 24, 2021)

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Declaración del Examinador Médico - Form 147-E

Medical-Examiner-Statement-Form147E-Spanish_2021.pdf 324.11 KB (Last Modified on October 7, 2021)

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Autorización Para Tomar Medicinas - Form 157

Medication-Authorization-Form157-Spanish_2021.pdf 222.13 KB (Last Modified on June 24, 2021)

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Consentimiento Médico - Form 156

Medical_Consent_Form_156_-_Spanish_2021.pdf 108.68 KB (Last Modified on June 24, 2021)

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Formulario de Inventario de Salud del Estudiante - Form 143

Student Health Inventory Form Spanish.pdf 56.5 KB (Last Modified on October 5, 2018)

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Formulario para la Presentación de el Certificado de Ausenica de Tuberculosis - Form 603

TB_Clearance_Form_Spanish 11.22.pdf 427.46 KB (Last Modified on November 10, 2022)

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Formulario de Verificación de Enfermedad Crónica (CIVF)

Chronic Illness Fillable Form - Spanish.pdf 672.6 KB (Last Modified on February 22, 2023)

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Requisitos de inmunización (A partir del 1 de julio de 2019)

Updated_Immunization_Requirements-Spanish_July1_2019.pdf 369.12 KB (Last Modified on August 15, 2022)

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Health Forms (Chinese)

突發心臟病行動計劃

General Seizure Action Plan-Simplified Chinese_2021.pdf 999.69 KB (Last Modified on August 5, 2022)

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醫療緊急指引/健康護理計劃 Form 151

Emergency Care Plan - Chinese Form_151.pdf 1.09 MB (Last Modified on June 24, 2021)

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体检医师声明 Form 147-E

Medical-Examiner-Statement-Form147E-Chinese_2021.pdf 782.81 KB (Last Modified on October 7, 2021)

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在學校期間服用藥物的授權 Form 157

Medication-AuthorizationForm157-Chinese_2021.pdf 685.15 KB (Last Modified on June 24, 2021)

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授權使用或公開健康資訊 Form 156

Medical_Consent_Form_156_-_Chinese_2021.pdf 334.02 KB (Last Modified on June 24, 2021)

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學生健康清單 Form 143

Form 143 Student Health Inventory Chinese.pdf 81.8 KB (Last Modified on April 19, 2018)

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無肺結核表格 Form 603

Form 603 TB Clearance Form Chinese.pdf 359.76 KB (Last Modified on April 19, 2018)

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慢性病证明表 (CIVF)

Chronic Illness Fillabhle Form - Chinese.pdf 1.25 MB (Last Modified on February 22, 2023)

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圣马刁联合高中区学生的免疫要求 (2019 年 7 月 1 日起)

Updated_Immunization_Requirements-Chinese_July1_2019.pdf 475.31 KB (Last Modified on August 15, 2022)

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San Mateo Union

High School District

A Commitment to Quality Education for a Better Future

Student Health

Health Forms (English)

Anaphylaxis Health Care Plan

Diabetes Health Care Plan

Seizure Action Plan

Emergency Care Plan Form 151

Medical Examiner's Statement Form 147-E

Medication Authorization Form 157

Medical Consent Form 156

Student Health Inventory Form 143

Tuberculosis Clearance Form 603

Chronic Illness Verification Form (CIVF)

Immunization Requirements (starting July 1, 2019)

Health Forms (Spanish)

Plan de salud anafilaxia

Plan de salud para la diabetes

Plan de accion para convulsiones

Emergencia Médica/Plan De Salud - Form 151

Declaración del Examinador Médico - Form 147-E

Autorización Para Tomar Medicinas - Form 157

Consentimiento Médico - Form 156

Formulario de Inventario de Salud del Estudiante - Form 143

Formulario para la Presentación de el Certificado de Ausenica de Tuberculosis - Form 603

Formulario de Verificación de Enfermedad Crónica (CIVF)

Requisitos de inmunización (A partir del 1 de julio de 2019)

Health Forms (Chinese)

突發心臟病行動計劃

醫療緊急指引/健康護理計劃 Form 151

体检医师声明 Form 147-E

在學校期間服用藥物的授權 Form 157

授權使用或公開健康資訊 Form 156

學生健康清單 Form 143

無肺結核表格 Form 603

慢性病证明表 (CIVF)

圣马刁联合高中区学生的免疫要求 (2019 年 7 月 1 日起)

San Mateo Union High School District