Health Forms and Information 

• Flu Vaccine 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 

• How to File A Claim/Medical Expense Certificate
• Coverage and Exclusions

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 Dr. Gregory Monroe, Director of Student Services at 252-514-6341