Student Health Resources – For Parent & Guardians

• Southwest Utah Public Health Department (SUPHD)
• Family Healthcare Clinic (FHC)
•  Contact Info sheet for  Health Department and the Family Healthcare Clinic
• Southwest Behavioral Health Center Center (SBHC)
• Doctor’s Volunteer Clinic
• Washington County Children’s Justice Center (CJC) – Assistance for children who are victims of abuse or other crimes. 

• Utah Department of Health K-12 School Recommendations

Both forms below must be filled out and signed by a parent/guardian and a licensed healthcare provider for students that need food related accommodations for meals/snacks at school. Contact your school nurse to see if a healthcare/emergency plan may also be needed. These diet forms only need to be updated if  a change is necessary.

• Medical Statement to Request Special Meals
• Medical Statement to Request Special Meal – Spanish
• Medical Authority Checklist
• Medical Authority Checklist – Spanish

The Department of Health’s Wellness and School Nursing  Website is a great resource for a variety of topics relating to Health Care for K-12 students and parents.  You can access this site HERE

• Immunization Requirements Flyers
• Immunization Exemptions– General Info
• Immunization Exemption Education Module for Parents
• Vaccine Exemptions for Students Entering 7th Grade – FAQ’s

• UDOH Getting Rid of Head Lice  Parent Handout
• UDOH Getting Rid of Head Lice Parent Handout – Spanish
• UDOH Head Lice Control Guidelines Booklet
• UDOH Head Lice Control Guidelines Booklet – Spanish 
• Head Lice WCSD Administrative Letter/Policy

Medical forms must be filled out and signed by a parent/guardian, and a licensed healthcare provider if medication is to be administered.  Click links below for forms.

Medication Authorizations (Orders)/IHP/EAP Forms  – UDOH

• Allergy Emergency Plan
• Asthma Action Plan
• Diabetes Emergency Plan
• Diabetes Healthcare Plan
• DMMO (Diabetes Medication Management Order)
• Diabetes CGM (Continuous Glucose Monitor) Addendum
• Diabetes Injection (pens-syringe & vial) Addendum
• Diabetes Pump/Smart Pen Addendum
• Generic IHP/EAP
• School Medication Authorization- for general medications that do not have a medication specific form  ( ex: ADHD meds, oxygen, Tylenol, G tube meds, pancreatic enzymes, etc.)
• Seizure Action Plan (IHP/EAP)
• SMMO (Seizure Medication Management Order)

Procedure Forms – WCSD

• Enteral Feeding  (G tube, J tube) Authorization 
• Medical Procedure Authorization Form

 Miscellaneous Forms-WCSD

• Medication Calendar – 2022-23
• Medication Calendar – blank
• Medication Incident Report
• Medical Release Form   editable  or    PDF              spanish editable       spanish PDF
• Medical Release to Return to School After Surgery
• Medical History   English –   Spanish
• Parent Permission Only- Student Medication Self-Administration (6 -12th grade only)

WCSD Medication Policy

• Medication Policy for Students 2320

Training Videos 

• How to Recognize an Opioid Overdose video 
• Naloxone Intranasal video
• Naloxone Injection video

Printable Handouts

• Common Opioids  Page 1
• Signs/Symptoms of Overdose – How to Give Naloxone  Page 2
• Naloxone (NARCAN) Nasal Spray Instructions
• Naloxone Pocket Card
• Naloxone Brochure – Signs/Symptoms of Overdose, Who’s at Risk, What to Do/What is Naloxone/How to Give Naloxone

Virtual Training- preregister here, attend the online, scheduled virtual training, and you will be sent a free injectable naloxone rescue kit.  All information collected is completely confidential.

School Nurse List