PWCS Health Forms

School Entrance Requirements

Kindergarten/New Student Enrollment--Per Virginia Code and PWCS Regulation 723-5 and Regulation 723-6, all Preschool, Kindergarten and new to the county students are required to submit a Virginia School Entrance Health (Physical) Form and immunization record completed by a licensed provider prior to the first day of school. School entrance physicals must be completed within one year of entry. Students are not allowed to start school without a physical and immunization record on file. This means that for the 2023-2024 school year, physicals must be completed and dated after August 22, 2022. Students who were previously enrolled in a PWCS preschool program, through Headstart or child find, are also required to submit an updated physical that falls within the dates above. This is in accordance with the Virginia Department of Education school entrance requirements and is a requirement for both in person and virtual schooling within the county.

 

**Effective July 1, 2021** A minimum of 2 doses of Hepatitis A vaccine are required for school entry. The first dose should be administered at age 12 months or older.

 

School Health Enrollment Form Instructions

Commonwealth of Virginia Minimum Immunization Requirements

Religious Exemption Form

 

Health Treatment Plans (HTP)

Nursing interventions are regulated by your student's doctor's orders or by our district policies. It is the parent/guardian's responsibility to provide the school nurse with medical orders from your doctor as well as all medications and supplies that are required for your student. The school does not provide any medications or supplies other than some basic first aid.

Health treatment plans need to be completed by the student's physician and delivered to the nurse at the start of each school year. Any medications required by the HTP must be hand delivered by the parent or guardian in the original, unopened packaging with prescription label intact and unexpired. Students are NOT permitted to transport medications to and from school. Please see below for applicable forms.

 

 

Authorization to Implement Health Treatment Plan (HTP)-This form must accompany ALL PWCS HTPs.

Virginia Asthma Action Plan

Updated Virginia Diabetes Medical Management Plan (DMMP)

Seizure Action Plan

Cancer Care Plan

Authorization for Medication Administration Form

Food Allergy & Anaphylaxis Emergency Care Plan

Request for Administration of Medication for Allergic Reactions

Student Epinephrine Self Carry Authorization

Severe Allergy Individual Health Care Plan

Student Allergy History Form

Release of Medical Information Authorization

Medical Procedure Treatment Plan

Tube Feeding Treatment Plan

Clean Intermittent Catheterization Treatment Plan