Forms
Authorization for Prescribed Medication/Drug or Treatment
This is required for all prescription medications administered at school. Parent's and prescriber's signatures are required.
Authorization for nonprescribed medication or treatment ELEMENTARY
This is required for all nonprescribed medications or treatments administered at school, grades K-5. Parent signature required.
Authorization for nonprescribed medication or treatment MIDDLE SCHOOL and HIGH SCHOOL
This is required for all nonprescribed medications or treatments administered at school, grades 6-12. Parent signature required.
Permission for Student to Self-Carry Epinephrine Auto-Injection Medication
Permission for Student to Self-Carry Asthma Inhaler/Other Emergency Medications
Ohio Immunization Summary for School Attendance
Ohio Immunization Exemption Form
This form is for students who do not meet the state-required minimum for immunizations due to health/medical, religious, or philosophical reasons. Complete and return to your student's school. Immunization exemptions do not need to be completed every year. Please contact the clinic with any questions and/or concerns regarding this.