Health Care Plans & Forms

RCW 28A.210 requires that students with life-threatening conditions must have physician orders and a health care plan before attending school. This information may be shared with school district staff that have a "need to know," in order to provide a healthy, safe environment.

Click a link below to view or download a file.

• Request For Dietary Accommodations
• HS-112 Activity Restrictions
• HS-210A Authorization for Release of Information
• HS-210 Authorization for Exchange of Information
• HS-300A Medication Request Form
• HS-300B Self Carry Medication Request Form
• HS-550 Asthma Info Form
• HS-555 Asthma Health Care Plan 
• HS-598 Concussion Health Care Plan
• HS-630 Allergy Information
• HS-634 Severe Anaphylaxis Care Plan and Medication Orders
• HS-713 Seizure Combined Health Care Plan
• HS-714 Seizure VNS orders

Athletics & Activities

• PHYSICAL EXAMINATION FORM
  The recommended physical examination form – STAYS WITH YOUR DOCTOR

• MEDICAL ELIGIBILITY FORM
  The recommended medical clearance form – GIVE TO YOUR SCHOOL