{"id":1737,"date":"2023-04-05T13:31:29","date_gmt":"2023-04-05T19:31:29","guid":{"rendered":"https:\/\/www.washk12.org\/student-services\/?page_id=1737"},"modified":"2026-03-31T13:17:28","modified_gmt":"2026-03-31T19:17:28","slug":"forms-documents","status":"publish","type":"page","link":"https:\/\/www.washk12.org\/student-services\/forms-documents\/","title":{"rendered":"Health Forms &#038; Documents"},"content":{"rendered":"<h1>Health Forms \/ Documents<\/h1>\n<ul>\n<li>\n<h3>Diet Requests<\/h3>\n<div>\n<p>SPECIAL MEAL ACCOMMODATIONS\/FOOD ALLERGIES<\/p>\n<p>When a request for special meal accommodation is made for a student, school secretaries will provide parents\/guardians\u00a0 with the<span> instruction letter and required special meal accommodation form linked below.<\/span><\/p>\n<p>The form must be filled out and signed by a parent\/guardian and a licensed healthcare provider.\u00a0 Return the completed form to:<br \/>Kayla Alldredge<br \/>Child Nutrition Office<br \/>Email: kayla.alldredge@washk12.org \u00a0<\/p>\n<p>These diet forms only need to be updated if\u00a0 a change is necessary.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/10\/ENGLISH-MAF.pdf\">Medical Statement to Request Special Meals English<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/10\/SPANISH-MAF.pdf\">Medical Statement to Request Special Meal &#8211; Spanish<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Head Injury &#8211; Concussion<\/h3>\n<div>\n<p>A concussion is caused by a bump, blow, or jolt to the head. Concussions can also occur from a fall or blow to the body that causes the head to move rapidly back and forth. Even what seems to be a mild bump to the head can be serious.<\/p>\n<p><span>Head injuries or bumps should be monitored for signs and symptoms of a concussion.<\/span>\u00a0 Use the Flow Chart, Checklist, Parent Notification Letter, and Signs\/Symptoms Poster linked below to guide you.<\/p>\n<ul>\n<li><a href=\"https:\/\/schools.utah.gov\/schoolsafetyandstudentservices\/pdfs\/ConcussionSignsSymptomsChecklist.pdf\" target=\"_blank\" rel=\"noopener\">Head Injury Flow Chart<\/a><\/li>\n<li><a href=\"https:\/\/schools.utah.gov\/schoolsafetyandstudentservices\/pdfs\/ConcussionSignsSymptomsChecklist.pdf\" target=\"_blank\" rel=\"noopener\">Head Injury Signs\/Symptoms Checklist\u00a0\u00a0<\/a><\/li>\n<li><a href=\"https:\/\/schools.utah.gov\/schoolsafetyandstudentservices\/pdfs\/ConcussionSignsSymptomsChecklistSpanish.pdf\" target=\"_blank\" rel=\"noopener\">Head Injury Signs\/Symptoms Checklist &#8211; Spanish<\/a><\/li>\n<li><a href=\"https:\/\/schools.utah.gov\/schoolsafetyandstudentservices\/pdfs\/ParentNotificationHeadInjuryDuringSchoolHours.pdf\" target=\"_blank\" rel=\"noopener\">Head injury Parent Notification Handout<\/a><\/li>\n<li><a href=\"https:\/\/schools.utah.gov\/schoolsafetyandstudentservices\/pdfs\/ParentNotificationHeadInjuryDuringSchoolHoursSpanish.pdf\" target=\"_blank\" rel=\"noopener\">Head Injury Parent Notification Handout &#8211; Spanish<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/tbi_poster_signs_symptoms.pdf\" target=\"_blank\" rel=\"noopener\">Head Injury Signs\/Symptoms\u00a0Poster &#8211; CDC\u00a0<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/10\/head-Injry-Signs-symptoms-Spanish.pdf\" target=\"_blank\" rel=\"noopener\">Head Injury SIgns\/Symptoms Poster- CDC &#8211; Spanish<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Health Office Tools<\/h3>\n<div>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/health_office-pass_dec19_2022.docx.pdf\" target=\"_blank\" rel=\"noopener\">Health Office Pass<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/7bs_poster.pdf\" target=\"_blank\" rel=\"noopener\">The 7 B&#8217;s Poster<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/8bs_when_to_send-to_the-office_pdf.pdf\" target=\"_blank\" rel=\"noopener\">The\u00a0 B&#8217;s Explanation Sheet<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Illness\/Communicable Disease<\/h3>\n<div>\n<p>The WCSD follows the guidance and recommendations provided by the Utah Department of Health and the American Academy of Pediatrics in regards to illness and communicable disease. Consult with your assigned school nurse as needed.\u00a0<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2024\/02\/Sick-Day-Guidelines1.docx.pdf\" target=\"_blank\" rel=\"noopener\">Sick Day Guidelines<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/exclusion_for_illness_or_medical_condition_11_2016.docx\" target=\"_blank\" rel=\"noopener\">Exclusion for Illness or Medical Condition &#8211; English\u00a0<\/a>\u00a0\u00a0\u00a0<a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/exclusion_for_illness__spanish.docx\" target=\"_blank\" rel=\"noopener\">Spanish<\/a><\/li>\n<li><a title=\"Exclusion for Illness - Millcreek Nursery\" href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/exclusion_for_illness-millcreek_nursery_11_2016.doc\" target=\"_blank\" rel=\"noopener noreferrer\">Exclusion for Illness &#8211; Millcreek Nursery<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/exclusion__letter_for_vaccine__preventable_disease.doc\" target=\"_blank\" rel=\"noopener\">Exclusion Letter- Vaccine Preventable Outbreak<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/school_health_concerns_parent_letter_exposure_to_illness.doc\" target=\"_blank\" rel=\"noopener\">Exposure to Communicable Disease- Parent Letter<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/udoh_guidelines_for_communicable_disease_updated_2017.docx\" target=\"_blank\" rel=\"noopener\">UDOH Guidelines for Communicable Disease<\/a><\/li>\n<\/ul>\n<p>Chicken Pox<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/udoh_chicken_pox__school_policy.pdf\" target=\"_blank\" rel=\"noopener\">Utah Department of Health (UDOH) Chicken Pox Policy<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/udoh_chicken_pox__school_report_form.pdf\" target=\"_blank\" rel=\"noopener\">UDOH Chicken Pox Report Form<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/chicken_pox_outbreak_notification_letter.doc\" target=\"_blank\" rel=\"noopener\">Chicken Pox Outbreak &#8211; Parent Notification Letter\u00a0<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/chicken_pox_factsheet.pdf\" target=\"_blank\" rel=\"noopener\">Chicken Pox Fact Sheet<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/chicken_pox_exclusion_letter_unvaccinated.docx\" target=\"_blank\" rel=\"noopener\">Chicken Pox Exclusion Letter for Unvaccinated Students During Outbreak<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Immunizations<\/h3>\n<div>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/conditional_enrollment-notice-english_2022-23.docx\" target=\"_blank\" rel=\"noopener\">Conditional Enrollment &#8211; Parent Letter<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/conditional-enrollment-notice-spanish_2022-23.docx\" target=\"_blank\" rel=\"noopener\">Conditional Enrollment &#8211; Parent Letter &#8211; Spanish<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/exclusion_notice_eng.pdf\" target=\"_blank\" rel=\"noopener\">Exclusion for\u00a0\u00a0Inadequate Immunizations &#8211; Parent Letter<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/images\/departments\/student_services\/immunizations\/exclusion_notice_eng.pdf\" target=\"_blank\" rel=\"noopener\"><\/a><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/exclusion_notice_spanish.docx\" target=\"_blank\" rel=\"noopener\">Exclusion for\u00a0Inadequate Immunizations Parent Letter &#8211; Spanish<\/a><\/li>\n<li><a href=\"https:\/\/immunize.utah.gov\/information-for-the-public\/immunization-recommendations\/school-childcare-immunization-requirements\/\" target=\"_blank\" rel=\"noopener\">Flyers\/Handouts &#8211; Immunization Requirements\u00a0<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/pink__card_usir_2021.pdf\" target=\"_blank\" rel=\"noopener\">Pink Card \/Utah State Immunization Record (USIR) Form<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/pink_card_how_to_fill_out.pdf\" target=\"_blank\" rel=\"noopener\">Pink Card\u00a0How To\u00a0Fill Out<\/a><\/li>\n<li><a href=\"https:\/\/immunize.utah.gov\/wp-content\/uploads\/Immunization-Guidebook-2025-2026.pdf\" target=\"_blank\" rel=\"noopener\">Utah Immunization Guidebook 2025-26<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/wcsd_immunization_policy.pdf\" target=\"_blank\" rel=\"noopener\">WCSD Immunization Policy<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Injury<\/h3>\n<div>\n<p>FOR STUDENT INJURIES:\u00a0<\/p>\n<p>A student injury severe enough to cause the loss of one-half day or more of school and\/or warrant medical attention and treatment needs to be reported by school secretaries to the Utah Dept. of Health &#8220;Student Injury Report&#8221; &#8211;\u00a0 Violence and Injury Program online:<a href=\"https:\/\/sir.health.utah.gov\/\"><br \/><\/a><\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/07\/REDCap-accounts-2.pdf\" target=\"_blank\" rel=\"noopener\">SIR<\/a>S Instruction Manual<\/li>\n<\/ul>\n<p>FOR STAFF INJURIES:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/risk\/workplace-injuries\/\" target=\"_blank\" rel=\"noopener\">WCSD Workplace Injury Instructions<\/a><\/li>\n<li><a href=\"https:\/\/procedure.washk12.org\/policy\/1000\/1520\" target=\"_blank\" rel=\"noopener\">District Policy 1520 &#8211; Employee Accident Reporting<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Lice \/ Bedbugs<\/h3>\n<div>\n<p>Lice<\/p>\n<p>Coordinate with your assigned school nurse for assistance with challenging cases and re-infestations. Provide parents with instructional materials linked below. Each school may order lice treatment kits\u00a0 through the warehouse.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/wcsd_lice___administrative_letter.pdf\" target=\"_blank\" rel=\"noopener\">Head Lice WCSD Administrative Letter\/Policy<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/flyer_schools-childcares_eng_udoh.pdf\" target=\"_blank\" rel=\"noopener\">Head Lice -Info for Schools &#8211; UDOH<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/lice_letter_to_parent_english.doc\" target=\"_blank\" rel=\"noopener\">Head Lice &#8211; Parent Letter<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/lice_letter_to_parent_spanish.doc\" target=\"_blank\" rel=\"noopener\">Head Lice &#8211; Parent Letter\u00a0 (Spanish)<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/09\/Head-Lice_-What-Parents-Need-to-Know-HealthyChildren.org_.pdf\" target=\"_blank\" rel=\"noopener\">Head Lice:What Parents Need to Know <\/a> \u00a0 \u00a0 \u00a0<\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2026\/02\/Head-Lice-What-Parents-Need-to-Know-Spanish.pdf\" target=\"_blank\" rel=\"noopener\">Head Lice: What Parents Need to Know (Spanish)<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/getting_rid_of_lice_parents_eng_udoh.pdf\" target=\"_blank\" rel=\"noopener\">UDOH Getting Rid of Head Lice\u00a0 Parent Handout<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/getting_rid_of_lice__parents_spanish_udoh.pdf\" target=\"_blank\" rel=\"noopener\">UDOH Getting Rid of Head Lice Parent Handout (Spanish)<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/control_guidelines_udoh_eng_.pdf\" target=\"_blank\" rel=\"noopener\">UDOH Head Lice<span>\u00a0<\/span><em>Control Guidelines<\/em><span>\u00a0<\/span>Booklet<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/control_guidelines_udoh_spanish.pdf\" target=\"_blank\" rel=\"noopener\">UDOH Head Lice<span>\u00a0<\/span><em>Control Guidelines<\/em><span>\u00a0<\/span>Booklet &#8211; (Spanish)<\/a>\u00a0<\/li>\n<\/ul>\n<p>Bed Bugs<\/p>\n<ul>\n<li>For assistance, contact Shallen Sterner, Southwest Utah Public Health Department, Environmental Health- 435-986-2580<\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/wcsd_bed_bug_inspection_letter.docx\" target=\"_blank\" rel=\"noopener\">WCSD Bed Bug Inspection Letter to Parent<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/bed_bug_guide_udoh.pdf\" target=\"_blank\" rel=\"noopener\">EPA Bed Bug Guidance for school Administrators, Teachers, and Staff<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/facts_about_bed_bugs_udoh.pdf\" target=\"_blank\" rel=\"noopener\">Bed Bug Parent Fact Sheet &#8211; UDOH<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/bed_bug_guide_udoh.pdf\" target=\"_blank\" rel=\"noopener\">\u00a0Preventing &amp; Getting Rid of Bed Bugs Safely &#8211; UDOH Booklet\u00a0for Parents and Schools<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/bed_bug_life_cycle.pdf\" target=\"_blank\" rel=\"noopener\">Bed Bug Life Cycle<\/a><\/li>\n<li><a href=\"https:\/\/www.youtube.com\/watch?v=bnbV0PsY7To\" target=\"_blank\" rel=\"noopener\">Bed Bug video &#8211; Spanish<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/bed_bug_prevention_spanish.pdf\" target=\"_blank\" rel=\"noopener\">Bed Bug Prevention\/Treatment Handout- Spanish<\/a><\/li>\n<li><a href=\"https:\/\/epi.utah.gov\/bed-bugs\/\" target=\"_blank\" rel=\"noopener\">Utah Epidemiology Bed Bugs Website<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Logs<\/h3>\n<div>\n<p>Diabetes Logs<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2026\/03\/Diabetes-Log-Word-4.docx\" target=\"_blank\" rel=\"noopener\">Daily Diabetes Log word\u00a0<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/diabetes_log__excell_version.xlsx\" target=\"_blank\" rel=\"noopener\">Daily Diabetes Log excel<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/diabetic_log_multiple_months.xlsx\" target=\"_blank\" rel=\"noopener\">Daily Diabetes Log- multiple months\u00a0 separated excel<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/bg_log_teacher.docx\" target=\"_blank\" rel=\"noopener\">Teacher Blood Glucose Log<\/a><\/li>\n<\/ul>\n<p>Other logs<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/gastrostomy_feeding_log.docx\" target=\"_blank\" rel=\"noopener\">G tube\/J tube Feeding Log\u00a0<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/heart_rate_medication_log.docx\" target=\"_blank\" rel=\"noopener\">Heart Rate Log- prn med<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/nebulizer_treatment_log.doc\" target=\"_blank\" rel=\"noopener\">Nebulizer Treatment Log<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/seizure_log_2016.pdf\" target=\"_blank\" rel=\"noopener\">Seizure Log<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/tracheostomy__o2_log.doc\" target=\"_blank\" rel=\"noopener\">Tracheostomy\u00a0 Suction &#8211; O2 Log<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Maturation<\/h3>\n<div>\n<p>Coordinate with your assigned school nurse, the PTA, and a male presenter to schedule a date\/time for the 5th grade Maturation presentation. Boys and girls are taught separately. Schools typically prefer presentations to be in the\u00a0 afternoon, right before a holiday or break.<\/p>\n<p>Per Utah State Board of Education (USBE), parents must receive the consent form linked below no later than two weeks prior to the beginning of instruction.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/09\/ConsentFormMaturation1-USBE.pdf\" target=\"_blank\" rel=\"noopener\">Maturation Parent Consent Form<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/consent__form_maturation_spanish.pdf\" target=\"_blank\" rel=\"noopener\">Maturation Parent Consent Form &#8211; Spanish<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Medication \/ Medical Forms<\/h3>\n<div>\n<p>Medical forms must be filled out and signed by a parent\/guardian, and a licensed healthcare provider if medication is to be administered.\u00a0 Click links below for individual forms. Quick access to all <a href=\"https:\/\/heal.utah.gov\/schools\/school-nursing\/\" target=\"_blank\" rel=\"noopener\">Utah Department of Health and Human Services medical forms found here.<\/a><\/p>\n<p>Medication Authorizations (Orders)\/EAP Forms\u00a0 &#8211; UDHHS<\/p>\n<ul>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/08\/AI-EAP-8-28-24.pdf\" target=\"_blank\" rel=\"noopener\">Adrenal Insufficiency Emergency Action Plan<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/09\/AAEAP-9-3-24.pdf\" target=\"_blank\" rel=\"noopener\">Allergy Emergency Plan<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/04\/Asthma-AP-4-29-24.pdf\" target=\"_blank\" rel=\"noopener\">Asthma Action Plan<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2025\/10\/DMMP.pdf\" target=\"_blank\" rel=\"noopener\">DMMP (Diabetes Medical Management Plan- updated Oct 2025)<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/08\/Generic-EAP-08_2025-1.docx\" target=\"_blank\" rel=\"noopener\">Generic EAP<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/09\/Medical-Diagnosis.pdf\" target=\"_blank\" rel=\"noopener\">Medical Diagnosis Confirmation Template<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/12\/Medication-Authorization-12-31-24.pdf\" target=\"_blank\" rel=\"noopener\">School Medication Authorization- for general medications that do not have a medication specific form\u00a0 ( ex: ADHD meds, oxygen, Tylenol, G tube meds, pancreatic enzymes, etc.)<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/04\/Seizure-SAP-4-29-24.pdf\" target=\"_blank\" rel=\"noopener\">Seizure Action Plan (IHP\/EAP)<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/04\/Seizure-SMMO-4-25-24.pdf\" target=\"_blank\" rel=\"noopener\">SMMO (Seizure Medication Management Order)<\/a><\/li>\n<\/ul>\n<p>Procedure Forms &#8211; WCSD<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/wcsd_enteral_feeding_authorization_1.doc\" target=\"_blank\" rel=\"noopener\">Enteral Feeding\u00a0 (G tube, J tube) Authorization\u00a0<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/08\/medical_procedure_authorization.pdf\" target=\"_blank\" rel=\"noopener\">Medical Procedure Authorization Form<\/a><\/li>\n<\/ul>\n<p>\u00a0Miscellaneous Forms-WCSD<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/07\/Medication_Calendar_2025-2026.docx-1.pdf\" target=\"_blank\" rel=\"noopener\">Medication Calendar &#8211; 2025-26<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/medication_calendar_2016.docx\" target=\"_blank\" rel=\"noopener\">Medication Calendar &#8211; blank<\/a><\/li>\n<li><a href=\"http:\/\/chrome-extension:\/\/efaidnbmnnnibpcajpcglclefindmkaj\/https:\/\/heal.utah.gov\/wp-content\/uploads\/2022\/11\/Sample-Error-Form-11-29-22.pdf\" target=\"_blank\" rel=\"noopener\">Medication Incident Report<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/medical_release_form.docx\" target=\"_blank\" rel=\"noopener\">Medical Release Form\u00a0 \u00a0editable<\/a>\u00a0 or\u00a0 \u00a0\u00a0<a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/medical_release_form.pdf\" target=\"_blank\" rel=\"noopener\">PDF<\/a>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<span>\u00a0<\/span><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/spanish-medical_release_form_15_1.docx\" target=\"_blank\" rel=\"noopener\">spanish editable<\/a>\u00a0 \u00a0 \u00a0 \u00a0<a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/spanish-medical_release_form_15_.pdf\" target=\"_blank\" rel=\"noopener\">spanish PDF<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/medical_release_to_return_to_school_after_surgery-injury.docx\" target=\"_blank\" rel=\"noopener\">Medical Release to Return to School After\u00a0Surgery<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/medical_history_form_feb_2021.pdf\" target=\"_blank\" rel=\"noopener\">Medical History\u00a0 \u00a0English &#8211;<\/a>\u00a0<span>\u00a0<\/span><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/medical_history_form_march_2021_in_spanish_1.docx\" target=\"_blank\" rel=\"noopener\">\u00a0Spanish<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/parent_permission__student_medication_selfadministration_form.docx\" target=\"_blank\" rel=\"noopener\">Parent Permission Only- Student Medication Self-Administration (6 -12th grade only)<\/a><\/li>\n<\/ul>\n<p>WCSD Medication Policy<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/district_medication_policy__2320__updated_2018-1.pdf\" target=\"_blank\" rel=\"noopener\">Medication Policy for Students 2320<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>School Disposition Tally Sheet<\/h3>\n<div>\n<p>The Utah Department of Health and Human Services requires our schools to keep track of the number of students that come to the main office for assistance, including whether the dispostition, meaning whether the students return to class, go home, or if 911 is called. No personal data is collected, only numbers and dispostiton.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/08\/Disposition-Tally-Sheet-2024-25-School-Staff-Copy-1-2.docx\" target=\"_blank\" rel=\"noopener\">Disposition Tally Sheet<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Scoliosis<\/h3>\n<div>\n<p>The WCSD school nurses perform spinal\/scoliosis screenings at the request of a parent\/guardian. The Utah Department of Health recommends against mass routine school scoliosis screening. The Spinal Research Society recommends that girls be screened twice at\u00a0 ages 10 and 12 (5<sup>th<\/sup><span>\u00a0<\/span>&amp; 7<sup>th<\/sup><span>\u00a0<\/span>grade), and boys be screened once at either age 13 or 14 (8<sup>th<\/sup><span>\u00a0<\/span>or 9<sup>th<\/sup><span>\u00a0<\/span>grade).<\/p>\n<p>Coordinate with your assigned school nurse to\u00a0 determine when to send home the Parent\u00a0 Scoliosis Letter and Instructional Handout.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/scoliosis_screening_letter_to_parents_request_option.docx\" target=\"_blank\" rel=\"noopener\">Parent Spinal \/ Scoliosis Screening Letter<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2024\/02\/Evaluacion-de-la-Columna-Vertebral-para-padres-1.docx\" target=\"_blank\" rel=\"noopener\">Parent Spinal\/Scoliosis Screening Letter (Spanish)<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/parent_how_to_screen_at_home__2_page.pdf\" target=\"_blank\" rel=\"noopener\">Parent Handout- How to &#8211; Instructions for Home Scoliosis Screening<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/07\/Scoliosis_Brochure_2015_Spanish-1-1-1.pdf\" target=\"_blank\" rel=\"noopener\">Parent Handout &#8211; How to-Instructions for Home Scoliosis Screening (Spanish)<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/scoliosis_referral__form_2017_english.docx\" target=\"_blank\" rel=\"noopener\">Spinal Screening\u00a0Referral Letter<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Standards of Care<\/h3>\n<div>\n<p>Listed below are the Utah Department Health (UDOH) general standards of care for students with medical concerns. The student\u2019s\u00a0 health care provider may indicate exceptions to these standards on the student\u2019s individual medication authorization form (order)\/Emergency Action Plan (EAP) forms. The school nurse ultimately determines if the authorization\/order is safe and appropriate to delegate to unlicensed school staff.<\/p>\n<ul>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/02\/SOC-allergy-and-anaphylaxis-January-2024.pdf\" target=\"_blank\" rel=\"noopener\">Standards of Care Anaphylaxis<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/02\/SOC-asthma-January-2024.pdf\" target=\"_blank\" rel=\"noopener\">Standards of Care Asthma<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/11\/SOC-diabetes-11-8-24-.pdf\" target=\"_blank\" rel=\"noopener\">Standards of Care Diabetes<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/04\/SOC-food-in-schools-4-25-24.pdf\" target=\"_blank\" rel=\"noopener\">Standards of Care: Outside Food in Schools<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/02\/SOC-pediculosis-January-2024.pdf\" target=\"_blank\" rel=\"noopener\">Standards of Care Head Lice<\/a><a href=\"https:\/\/heal.health.utah.gov\/wp-content\/uploads\/2021\/07\/SOC-Head-Lice-3-17-17.pdf\" target=\"_blank\" rel=\"noopener\"><br \/><\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/02\/SOC-seizure-January-2024.pdf\" target=\"_blank\" rel=\"noopener\">Standards of Care Seizure<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Standing Orders<\/h3>\n<div>\n<p>The Medical Director for the WCSD has written orders for a variety of Over The Counter (OTC) products that can be used by trained staff to treat students.\u00a0 School staff must obtain parent\/guardian permission each time a Standing Order OTC product is administered, unless the student has a specific medication authorization form (order) completed and signed by a parent\/guardian and their healthcare provider. Documentation of each medication administration in the student&#8217;s personal educational record is required.<\/p>\n<p>Additionally, the WCSD Medical Director has written Standing Orders for emergency use of stock Epi-Pen (for severe allergic reaction) and naloxone (for opioid over-dose)\u00a0 that can be administered by trained staff to any student, staff, and visitors. These emergency medications are to be administered as per the Standing Orders, then emergency services and parent\/guardian are to be contacted. If a student has an emergency action plan\/medication authorization for epinephrine auto-injector\/nasal epinephrine or naloxone, follow the student&#8217;s specific emergency action plan\/medication authorization form (order) completed and signed by a parent\/guardian and their healthcare provider.\u00a0<\/p>\n<p>For quick reference, print the Standing Orders below and keep accessible.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/09\/Standing-Orders-2025-26.pdf\" target=\"_blank\" rel=\"noopener\">Standing Orders<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li>\n<h3>Vision Screening<\/h3>\n<div>\n<p>The Utah Department of Health (UDOH) requires Tier 1 screening of students for distance visual acuity for pre-kindergarten, kindergarten, and grades 1, 3, 5, 7 or 8, and 9 or 10. Tenth grade students may be screened as part of their driver education class. Students referred by a parent or school personnel should also be screened during any grade. Students in the grades listed above must be screened annually.<\/p>\n<p>Tier 2 vision screening is a higher-level evaluation which should include screening of distance (if not done in the current year) and near vision. Optional screening includes eye focusing or tracking problems, and convergence insufficiency. Tier 2 vision screening can be classified as mandatory (students needing educational intervention, special education referral, or failing benchmark assessment) or optional (teacher or parent concern).<\/p>\n<p>For financial assistance for a professional eye exam and if needed, glasses, contact your assigned school nurse or the WCSD Support Services Coordinator\/ Homeless Liaison.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2024\/02\/vision_screening_notification_letter_english-Tier-1-and-Tier-2.doc\" target=\"_blank\" rel=\"noopener\">Parent Vision Screening Notification Letter<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/09\/Spanish-Translated-copy-of-vision_screening_notification_letter_english-Tier-1-and-Tier-2-1.pdf\" target=\"_blank\" rel=\"noopener\">Parent Vision Screening Notification Letter &#8211; Spanish<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/opt_out_vision_eng.docx\" target=\"_blank\" rel=\"noopener\">Vision Screening Opt Out Form<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2025\/09\/Spanish-copy-of-opt_out_vision.pdf\" target=\"_blank\" rel=\"noopener\">Vision Screening Opt Out Form &#8211; Spanish<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/images\/departments\/student_services\/health_forms\/vision_referral_letter_english.pdf\" target=\"_blank\" rel=\"noopener\"><\/a><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/vision_referral_letter_english_blank.pdf\" target=\"_blank\" rel=\"noopener\">Vision Screening Referral Form<\/a><\/li>\n<li><a href=\"https:\/\/www.washk12.org\/student-services\/wp-content\/uploads\/sites\/9\/2023\/04\/vision_referral_letter_spanish.pdf\" target=\"_blank\" rel=\"noopener\">Vision Screening Referral Form &#8211; Spanish<\/a><\/li>\n<li><a href=\"https:\/\/heal.utah.gov\/wp-content\/uploads\/2024\/10\/Vision-Symptoms-Questionnaire-10-03-24.pdf\" target=\"_blank\" rel=\"noopener\">Vision Symptoms Questionnaire\u00a0Tier 2 Screening<\/a><\/li>\n<\/ul>\n<\/div>\n<\/li>\n<\/ul>\n<p><!--more--><br \/>\n<!-- {\"type\":\"layout\",\"children\":[{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"position_sticky_breakpoint\":\"m\"},\"children\":[{\"type\":\"headline\",\"props\":{\"content\":\"Health Forms \\\/ Documents\",\"title_element\":\"h1\"}}]}]},{\"type\":\"row\",\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"position_sticky_breakpoint\":\"m\"},\"children\":[{\"type\":\"accordion\",\"props\":{\"collapsible\":true,\"content_column_breakpoint\":\"m\",\"image_align\":\"top\",\"image_grid_breakpoint\":\"m\",\"image_grid_width\":\"1-2\",\"image_svg_color\":\"emphasis\",\"link_style\":\"default\",\"link_text\":\"Read more\",\"show_image\":true,\"show_link\":true},\"children\":[{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>SPECIAL MEAL ACCOMMODATIONS\\\/FOOD ALLERGIES<\\\/p>\\n\n\n<p>When a request for special meal accommodation is made for a student, school secretaries will provide parents\\\/guardians\\u00a0 with the<span> instruction letter and required special meal accommodation form linked below.<\\\/span><\\\/p>\\n\n\n<p>The form must be filled out and signed by a parent\\\/guardian and a licensed healthcare provider.\\u00a0 Return the completed form to:<br \\\/>Kayla Alldredge<br \\\/>Child Nutrition Office<br \\\/>Email: kayla.alldredge@washk12.org \\u00a0<\\\/p>\\n\n\n<p>These diet forms only need to be updated if\\u00a0 a change is necessary.<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/10\\\/ENGLISH-MAF.pdf\\\">Medical Statement to Request Special Meals English<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/10\\\/SPANISH-MAF.pdf\\\">Medical Statement to Request Special Meal - Spanish<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Diet Requests\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>A concussion is caused by a bump, blow, or jolt to the head. Concussions can also occur from a fall or blow to the body that causes the head to move rapidly back and forth. Even what seems to be a mild bump to the head can be serious.<\\\/p>\\n\n\n<p><span>Head injuries or bumps should be monitored for signs and symptoms of a concussion.<\\\/span>\\u00a0 Use the Flow Chart, Checklist, Parent Notification Letter, and Signs\\\/Symptoms Poster linked below to guide you.<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/schools.utah.gov\\\/schoolsafetyandstudentservices\\\/pdfs\\\/ConcussionSignsSymptomsChecklist.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Injury Flow Chart<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/schools.utah.gov\\\/schoolsafetyandstudentservices\\\/pdfs\\\/ConcussionSignsSymptomsChecklist.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Injury Signs\\\/Symptoms Checklist\\u00a0\\u00a0<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/schools.utah.gov\\\/schoolsafetyandstudentservices\\\/pdfs\\\/ConcussionSignsSymptomsChecklistSpanish.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Injury Signs\\\/Symptoms Checklist - Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/schools.utah.gov\\\/schoolsafetyandstudentservices\\\/pdfs\\\/ParentNotificationHeadInjuryDuringSchoolHours.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head injury Parent Notification Handout<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/schools.utah.gov\\\/schoolsafetyandstudentservices\\\/pdfs\\\/ParentNotificationHeadInjuryDuringSchoolHoursSpanish.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Injury Parent Notification Handout - Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/tbi_poster_signs_symptoms.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Injury Signs\\\/Symptoms\\u00a0Poster - CDC\\u00a0<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/10\\\/head-Injry-Signs-symptoms-Spanish.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Injury SIgns\\\/Symptoms Poster- CDC - Spanish<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Head Injury - Concussion\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/health_office-pass_dec19_2022.docx.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Health Office Pass<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/7bs_poster.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">The 7 B's Poster<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/8bs_when_to_send-to_the-office_pdf.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">The\\u00a0 B's Explanation Sheet<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Health Office Tools\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>The WCSD follows the guidance and recommendations provided by the Utah Department of Health and the American Academy of Pediatrics in regards to illness and communicable disease. Consult with your assigned school nurse as needed.\\u00a0<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2024\\\/02\\\/Sick-Day-Guidelines1.docx.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Sick Day Guidelines<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/exclusion_for_illness_or_medical_condition_11_2016.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Exclusion for Illness or Medical Condition - English\\u00a0<\\\/a>\\u00a0\\u00a0\\u00a0<a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/exclusion_for_illness__spanish.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Spanish<\\\/a><\\\/li>\\n\n\n<li><a title=\\\"Exclusion for Illness - Millcreek Nursery\\\" href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/exclusion_for_illness-millcreek_nursery_11_2016.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener noreferrer\\\">Exclusion for Illness - Millcreek Nursery<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/exclusion__letter_for_vaccine__preventable_disease.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Exclusion Letter- Vaccine Preventable Outbreak<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/school_health_concerns_parent_letter_exposure_to_illness.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Exposure to Communicable Disease- Parent Letter<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/udoh_guidelines_for_communicable_disease_updated_2017.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">UDOH Guidelines for Communicable Disease<\\\/a><\\\/li>\\n<\\\/ul>\\n\n\n<p>Chicken Pox<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/udoh_chicken_pox__school_policy.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Utah Department of Health (UDOH) Chicken Pox Policy<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/udoh_chicken_pox__school_report_form.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">UDOH Chicken Pox Report Form<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/chicken_pox_outbreak_notification_letter.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Chicken Pox Outbreak - Parent Notification Letter\\u00a0<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/chicken_pox_factsheet.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Chicken Pox Fact Sheet<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/chicken_pox_exclusion_letter_unvaccinated.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Chicken Pox Exclusion Letter for Unvaccinated Students During Outbreak<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Illness\\\/Communicable Disease\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/conditional_enrollment-notice-english_2022-23.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Conditional Enrollment - Parent Letter<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/conditional-enrollment-notice-spanish_2022-23.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Conditional Enrollment - Parent Letter - Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/exclusion_notice_eng.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Exclusion for\\u00a0\\u00a0Inadequate Immunizations - Parent Letter<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/images\\\/departments\\\/student_services\\\/immunizations\\\/exclusion_notice_eng.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\"><\\\/a><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/exclusion_notice_spanish.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Exclusion for\\u00a0Inadequate Immunizations Parent Letter - Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/immunize.utah.gov\\\/information-for-the-public\\\/immunization-recommendations\\\/school-childcare-immunization-requirements\\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Flyers\\\/Handouts - Immunization Requirements\\u00a0<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/pink__card_usir_2021.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Pink Card \\\/Utah State Immunization Record (USIR) Form<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/pink_card_how_to_fill_out.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Pink Card\\u00a0How To\\u00a0Fill Out<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/immunize.utah.gov\\\/wp-content\\\/uploads\\\/Immunization-Guidebook-2025-2026.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Utah Immunization Guidebook 2025-26<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/wcsd_immunization_policy.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">WCSD Immunization Policy<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Immunizations\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>FOR STUDENT INJURIES:\\u00a0<\\\/p>\\n\n\n<p>A student injury severe enough to cause the loss of one-half day or more of school and\\\/or warrant medical attention and treatment needs to be reported by school secretaries to the Utah Dept. of Health \\\"Student Injury Report\\\" -\\u00a0 Violence and Injury Program online:<a href=\\\"https:\\\/\\\/sir.health.utah.gov\\\/\\\"><br \\\/><\\\/a><\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/07\\\/REDCap-accounts-2.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">SIR<\\\/a>S Instruction Manual<\\\/li>\\n<\\\/ul>\\n\n\n<p>FOR STAFF INJURIES:<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/risk\\\/workplace-injuries\\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">WCSD Workplace Injury Instructions<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/procedure.washk12.org\\\/policy\\\/1000\\\/1520\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">District Policy 1520 - Employee Accident Reporting<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Injury\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>Lice<\\\/p>\\n\n\n<p>Coordinate with your assigned school nurse for assistance with challenging cases and re-infestations. Provide parents with instructional materials linked below. Each school may order lice treatment kits\\u00a0 through the warehouse.<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/wcsd_lice___administrative_letter.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Lice WCSD Administrative Letter\\\/Policy<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/flyer_schools-childcares_eng_udoh.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Lice -Info for Schools - UDOH<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/lice_letter_to_parent_english.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Lice - Parent Letter<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/lice_letter_to_parent_spanish.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Lice - Parent Letter\\u00a0 (Spanish)<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/09\\\/Head-Lice_-What-Parents-Need-to-Know-HealthyChildren.org_.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Lice:What Parents Need to Know <\\\/a> \\u00a0 \\u00a0 \\u00a0<\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2026\\\/02\\\/Head-Lice-What-Parents-Need-to-Know-Spanish.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Head Lice: What Parents Need to Know (Spanish)<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/getting_rid_of_lice_parents_eng_udoh.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">UDOH Getting Rid of Head Lice\\u00a0 Parent Handout<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/getting_rid_of_lice__parents_spanish_udoh.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">UDOH Getting Rid of Head Lice Parent Handout (Spanish)<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/control_guidelines_udoh_eng_.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">UDOH Head Lice<span>\\u00a0<\\\/span><em>Control Guidelines<\\\/em><span>\\u00a0<\\\/span>Booklet<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/control_guidelines_udoh_spanish.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">UDOH Head Lice<span>\\u00a0<\\\/span><em>Control Guidelines<\\\/em><span>\\u00a0<\\\/span>Booklet - (Spanish)<\\\/a>\\u00a0<\\\/li>\\n<\\\/ul>\\n\n\n<p>Bed Bugs<\\\/p>\\n\n\n<ul>\\n\n\n<li>For assistance, contact Shallen Sterner, Southwest Utah Public Health Department, Environmental Health- 435-986-2580<\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/wcsd_bed_bug_inspection_letter.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">WCSD Bed Bug Inspection Letter to Parent<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/bed_bug_guide_udoh.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">EPA Bed Bug Guidance for school Administrators, Teachers, and Staff<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/facts_about_bed_bugs_udoh.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Bed Bug Parent Fact Sheet - UDOH<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/bed_bug_guide_udoh.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">\\u00a0Preventing &amp; Getting Rid of Bed Bugs Safely - UDOH Booklet\\u00a0for Parents and Schools<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/bed_bug_life_cycle.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Bed Bug Life Cycle<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.youtube.com\\\/watch?v=bnbV0PsY7To\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Bed Bug video - Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/bed_bug_prevention_spanish.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Bed Bug Prevention\\\/Treatment Handout- Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/epi.utah.gov\\\/bed-bugs\\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Utah Epidemiology Bed Bugs Website<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Lice \\\/ Bedbugs\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>Diabetes Logs<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2026\\\/03\\\/Diabetes-Log-Word-4.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Daily Diabetes Log word\\u00a0<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/diabetes_log__excell_version.xlsx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Daily Diabetes Log excel<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/diabetic_log_multiple_months.xlsx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Daily Diabetes Log- multiple months\\u00a0 separated excel<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/bg_log_teacher.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Teacher Blood Glucose Log<\\\/a><\\\/li>\\n<\\\/ul>\\n\n\n<p>Other logs<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/gastrostomy_feeding_log.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">G tube\\\/J tube Feeding Log\\u00a0<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/heart_rate_medication_log.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Heart Rate Log- prn med<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/nebulizer_treatment_log.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Nebulizer Treatment Log<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/seizure_log_2016.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Seizure Log<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/tracheostomy__o2_log.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Tracheostomy\\u00a0 Suction - O2 Log<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Logs\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>Coordinate with your assigned school nurse, the PTA, and a male presenter to schedule a date\\\/time for the 5th grade Maturation presentation. Boys and girls are taught separately. Schools typically prefer presentations to be in the\\u00a0 afternoon, right before a holiday or break.<\\\/p>\\n\n\n<p>Per Utah State Board of Education (USBE), parents must receive the consent form linked below no later than two weeks prior to the beginning of instruction.<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/09\\\/ConsentFormMaturation1-USBE.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Maturation Parent Consent Form<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/consent__form_maturation_spanish.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Maturation Parent Consent Form - Spanish<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Maturation\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>Medical forms must be filled out and signed by a parent\\\/guardian, and a licensed healthcare provider if medication is to be administered.\\u00a0 Click links below for individual forms. Quick access to all <a href=\\\"https:\\\/\\\/heal.utah.gov\\\/schools\\\/school-nursing\\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Utah Department of Health and Human Services medical forms found here.<\\\/a><\\\/p>\\n\n\n<p>Medication Authorizations (Orders)\\\/EAP Forms\\u00a0 - UDHHS<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/08\\\/AI-EAP-8-28-24.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Adrenal Insufficiency Emergency Action Plan<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/09\\\/AAEAP-9-3-24.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Allergy Emergency Plan<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/04\\\/Asthma-AP-4-29-24.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Asthma Action Plan<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2025\\\/10\\\/DMMP.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">DMMP (Diabetes Medical Management Plan- updated Oct 2025)<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/08\\\/Generic-EAP-08_2025-1.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Generic EAP<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/09\\\/Medical-Diagnosis.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Medical Diagnosis Confirmation Template<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/12\\\/Medication-Authorization-12-31-24.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">School Medication Authorization- for general medications that do not have a medication specific form\\u00a0 ( ex: ADHD meds, oxygen, Tylenol, G tube meds, pancreatic enzymes, etc.)<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/04\\\/Seizure-SAP-4-29-24.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Seizure Action Plan (IHP\\\/EAP)<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/04\\\/Seizure-SMMO-4-25-24.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">SMMO (Seizure Medication Management Order)<\\\/a><\\\/li>\\n<\\\/ul>\\n\n\n<p>Procedure Forms - WCSD<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/wcsd_enteral_feeding_authorization_1.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Enteral Feeding\\u00a0 (G tube, J tube) Authorization\\u00a0<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/08\\\/medical_procedure_authorization.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Medical Procedure Authorization Form<\\\/a><\\\/li>\\n<\\\/ul>\\n\n\n<p>\\u00a0Miscellaneous Forms-WCSD<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/07\\\/Medication_Calendar_2025-2026.docx-1.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Medication Calendar - 2025-26<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/medication_calendar_2016.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Medication Calendar - blank<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"http:\\\/\\\/chrome-extension:\\\/\\\/efaidnbmnnnibpcajpcglclefindmkaj\\\/https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2022\\\/11\\\/Sample-Error-Form-11-29-22.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Medication Incident Report<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/medical_release_form.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Medical Release Form\\u00a0 \\u00a0editable<\\\/a>\\u00a0 or\\u00a0 \\u00a0\\u00a0<a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/medical_release_form.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">PDF<\\\/a>\\u00a0 \\u00a0 \\u00a0 \\u00a0 \\u00a0 \\u00a0 \\u00a0<span>\\u00a0<\\\/span><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/spanish-medical_release_form_15_1.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">spanish editable<\\\/a>\\u00a0 \\u00a0 \\u00a0 \\u00a0<a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/spanish-medical_release_form_15_.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">spanish PDF<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/medical_release_to_return_to_school_after_surgery-injury.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Medical Release to Return to School After\\u00a0Surgery<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/medical_history_form_feb_2021.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Medical History\\u00a0 \\u00a0English -<\\\/a>\\u00a0<span>\\u00a0<\\\/span><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/medical_history_form_march_2021_in_spanish_1.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">\\u00a0Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/parent_permission__student_medication_selfadministration_form.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Parent Permission Only- Student Medication Self-Administration (6 -12th grade only)<\\\/a><\\\/li>\\n<\\\/ul>\\n\n\n<p>WCSD Medication Policy<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/district_medication_policy__2320__updated_2018-1.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Medication Policy for Students 2320<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Medication \\\/ Medical Forms\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>The Utah Department of Health and Human Services requires our schools to keep track of the number of students that come to the main office for assistance, including whether the dispostition, meaning whether the students return to class, go home, or if 911 is called. No personal data is collected, only numbers and dispostiton.<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/08\\\/Disposition-Tally-Sheet-2024-25-School-Staff-Copy-1-2.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Disposition Tally Sheet<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"School Disposition Tally Sheet\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>The WCSD school nurses perform spinal\\\/scoliosis screenings at the request of a parent\\\/guardian. The Utah Department of Health recommends against mass routine school scoliosis screening. The Spinal Research Society recommends that girls be screened twice at\\u00a0 ages 10 and 12 (5<sup>th<\\\/sup><span>\\u00a0<\\\/span>&amp; 7<sup>th<\\\/sup><span>\\u00a0<\\\/span>grade), and boys be screened once at either age 13 or 14 (8<sup>th<\\\/sup><span>\\u00a0<\\\/span>or 9<sup>th<\\\/sup><span>\\u00a0<\\\/span>grade).<\\\/p>\\n\n\n<p>Coordinate with your assigned school nurse to\\u00a0 determine when to send home the Parent\\u00a0 Scoliosis Letter and Instructional Handout.<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/scoliosis_screening_letter_to_parents_request_option.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Parent Spinal \\\/ Scoliosis Screening Letter<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2024\\\/02\\\/Evaluacion-de-la-Columna-Vertebral-para-padres-1.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Parent Spinal\\\/Scoliosis Screening Letter (Spanish)<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/parent_how_to_screen_at_home__2_page.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Parent Handout- How to - Instructions for Home Scoliosis Screening<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/07\\\/Scoliosis_Brochure_2015_Spanish-1-1-1.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Parent Handout - How to-Instructions for Home Scoliosis Screening (Spanish)<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/scoliosis_referral__form_2017_english.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Spinal Screening\\u00a0Referral Letter<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Scoliosis\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>Listed below are the Utah Department Health (UDOH) general standards of care for students with medical concerns. The student\\u2019s\\u00a0 health care provider may indicate exceptions to these standards on the student\\u2019s individual medication authorization form (order)\\\/Emergency Action Plan (EAP) forms. The school nurse ultimately determines if the authorization\\\/order is safe and appropriate to delegate to unlicensed school staff.<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/02\\\/SOC-allergy-and-anaphylaxis-January-2024.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Standards of Care Anaphylaxis<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/02\\\/SOC-asthma-January-2024.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Standards of Care Asthma<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/11\\\/SOC-diabetes-11-8-24-.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Standards of Care Diabetes<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/04\\\/SOC-food-in-schools-4-25-24.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Standards of Care: Outside Food in Schools<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/02\\\/SOC-pediculosis-January-2024.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Standards of Care Head Lice<\\\/a><a href=\\\"https:\\\/\\\/heal.health.utah.gov\\\/wp-content\\\/uploads\\\/2021\\\/07\\\/SOC-Head-Lice-3-17-17.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\"><br \\\/><\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/02\\\/SOC-seizure-January-2024.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Standards of Care Seizure<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Standards of Care\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>The Medical Director for the WCSD has written orders for a variety of Over The Counter (OTC) products that can be used by trained staff to treat students.\\u00a0 School staff must obtain parent\\\/guardian permission each time a Standing Order OTC product is administered, unless the student has a specific medication authorization form (order) completed and signed by a parent\\\/guardian and their healthcare provider. Documentation of each medication administration in the student's personal educational record is required.<\\\/p>\\n\n\n<p>Additionally, the WCSD Medical Director has written Standing Orders for emergency use of stock Epi-Pen (for severe allergic reaction) and naloxone (for opioid over-dose)\\u00a0 that can be administered by trained staff to any student, staff, and visitors. These emergency medications are to be administered as per the Standing Orders, then emergency services and parent\\\/guardian are to be contacted. If a student has an emergency action plan\\\/medication authorization for epinephrine auto-injector\\\/nasal epinephrine or naloxone, follow the student's specific emergency action plan\\\/medication authorization form (order) completed and signed by a parent\\\/guardian and their healthcare provider.\\u00a0<\\\/p>\\n\n\n<p>For quick reference, print the Standing Orders below and keep accessible.<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/09\\\/Standing-Orders-2025-26.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Standing Orders<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Standing Orders\"}},{\"type\":\"accordion_item\",\"props\":{\"content\":\"\n\n<p>The Utah Department of Health (UDOH) requires Tier 1 screening of students for distance visual acuity for pre-kindergarten, kindergarten, and grades 1, 3, 5, 7 or 8, and 9 or 10. Tenth grade students may be screened as part of their driver education class. Students referred by a parent or school personnel should also be screened during any grade. Students in the grades listed above must be screened annually.<\\\/p>\\n\n\n<p>Tier 2 vision screening is a higher-level evaluation which should include screening of distance (if not done in the current year) and near vision. Optional screening includes eye focusing or tracking problems, and convergence insufficiency. Tier 2 vision screening can be classified as mandatory (students needing educational intervention, special education referral, or failing benchmark assessment) or optional (teacher or parent concern).<\\\/p>\\n\n\n<p>For financial assistance for a professional eye exam and if needed, glasses, contact your assigned school nurse or the WCSD Support Services Coordinator\\\/ Homeless Liaison.<\\\/p>\\n\n\n<ul>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2024\\\/02\\\/vision_screening_notification_letter_english-Tier-1-and-Tier-2.doc\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Parent Vision Screening Notification Letter<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/09\\\/Spanish-Translated-copy-of-vision_screening_notification_letter_english-Tier-1-and-Tier-2-1.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Parent Vision Screening Notification Letter - Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/opt_out_vision_eng.docx\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Vision Screening Opt Out Form<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2025\\\/09\\\/Spanish-copy-of-opt_out_vision.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Vision Screening Opt Out Form - Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/images\\\/departments\\\/student_services\\\/health_forms\\\/vision_referral_letter_english.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\"><\\\/a><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/vision_referral_letter_english_blank.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Vision Screening Referral Form<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/www.washk12.org\\\/student-services\\\/wp-content\\\/uploads\\\/sites\\\/9\\\/2023\\\/04\\\/vision_referral_letter_spanish.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Vision Screening Referral Form - Spanish<\\\/a><\\\/li>\\n\n\n<li><a href=\\\"https:\\\/\\\/heal.utah.gov\\\/wp-content\\\/uploads\\\/2024\\\/10\\\/Vision-Symptoms-Questionnaire-10-03-24.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Vision Symptoms Questionnaire\\u00a0Tier 2 Screening<\\\/a><\\\/li>\\n<\\\/ul>\",\"title\":\"Vision Screening\"}}]}]}]}]}],\"version\":\"4.5.21\",\"yooessentialsVersion\":\"2.2.25\"} --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Health Forms \/ Documents Diet Requests SPECIAL MEAL ACCOMMODATIONS\/FOOD ALLERGIES When a request for special meal accommodation is made for a student, school secretaries will provide parents\/guardians\u00a0 with the instruction letter and required special meal accommodation form linked below. The form must be filled out and signed by a parent\/guardian and a licensed healthcare provider.\u00a0 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1737","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.washk12.org\/student-services\/wp-json\/wp\/v2\/pages\/1737","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.washk12.org\/student-services\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.washk12.org\/student-services\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.washk12.org\/student-services\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.washk12.org\/student-services\/wp-json\/wp\/v2\/comments?post=1737"}],"version-history":[{"count":116,"href":"https:\/\/www.washk12.org\/student-services\/wp-json\/wp\/v2\/pages\/1737\/revisions"}],"predecessor-version":[{"id":2913,"href":"https:\/\/www.washk12.org\/student-services\/wp-json\/wp\/v2\/pages\/1737\/revisions\/2913"}],"wp:attachment":[{"href":"https:\/\/www.washk12.org\/student-services\/wp-json\/wp\/v2\/media?parent=1737"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}