Health Forms
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Questions?
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marianiklesaintvdp.orgHealth Care Coordinator -
katielovgrensaintvdp.orgHealth Care Coordinator
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SVDP School works to make appropriate plans for those students with special health care needs. The primary responsibility for a student's health care rests with the parent/guardian. School health service is supportive health care that enables education of the student in a safe manner.
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What forms are needed?
Immunizations
To go to school in Minnesota, students must show they've had the required immunizations, or must file a legal exemption* with the school.
* Parents may file a medical exemption signed by a health care provider or provide conscientious objection signed by parent/guardian and notarized.
The following immunization form needs to be completed and turned in by the first day of school if:- The student is new to SVDP
- The student is entering kindergarten
- The students is entering 7th grade
Immunization Form
Conscientious Objection Form
Immunization InformationIf your student has received a COVID-19 vaccination, please email Nurse Maria so immunization records are up to date. Please include the date of vaccination(s) and the product name (Pfizer, Johnson & Johnson, or Moderna).
Medication Administration During School Day
If your student needs medication administered during the school day, please complete the following form each school year:
Medication Administration Consent
Self-Administration of Medication Authorization
Tylenol or other over-the-counter medicines will be administered only with a physician's written order, in addition to the parent authorization. Such over-the-counter medication must be in the original container.
Allergy
If your student has an allergy and needs medication at school, please complete the following forms each school year:
Medication Administration Consent
Anaphylaxis Action Plan
Asthma
If your student has asthma, please complete the following forms each school year:
Medication Administration Consent
Self-Administration of Inhaler
Asthma Action Plan
Diabetes
If your student has diabetes, please complete the following forms each school year:
Medication Administration Consent
Diabetes Emergency Care Plan
Seizure
If your student has a history of seizures, please complete the following forms each school year:
Medication Administration Consent
Seizure Action Plan
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Individualized Healthcare PlanAn Individualized Healthcare Plan (IHP) shall document the student's health concern/need, plan of care, and goals/desired outcomes. The IHP should also include an emergency plan if a student's condition may predictably result in an emergency situation. The IHP is written by the Registered Nurse, reviewed by the parent, and is filed in the student's health folder.
Information regarding a student's health needs will be shared with those personnel who need to know in order to work with that student. This information shall be considered private in accordance with federal and state data practices law.