Health Information
Health Forms
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Health Forms and Information
Health Assessment
- Health Assessment Form
- Health Assessment Form Spanish
Homebound/Medically Fragile (also see Student Support Services section on Homebound/Medically Fragile)
- HB Basic Information
- HB Parent Agreement to be signed by the parent
- HB Parent Referral to be completed and signed by the parent
- HB Release of Information to be completed and provided to the physician
- HB Physician Form to be completed by the physician
- HB Counselor Form to be completed by the school counselor
- Medically Fragile Physician Form to be completed by physician
Health/Nurse Forms
- Emergency Plan for the Student with Diabetes
- Authorization For Specialized Physical Health Care Service
- Emergency Plan for Students with Special Needs
- Emergency Care Plan for Students with Allergies
- Medication Authorization
- Medical Statement for Students with Unique Mealtime Needs
Student and Visitor Injury
Student Insurance
- Voluntary Student Accident Insurance Form English
- Voluntary Student Accident Insurance Form Spanish
- Claim Form
For questions related to Health Forms contact Luanne Mack at 252-514-6300
For questions related to Insurance contact Mike Swain, Director of Student Services at 252-514-6341
