District Status: Online Registration Ends Friday at Noon. Register for 2020-21 Now at fwcs.info/MyFWCS Fort Wayne Community Schools - Health Services - Plan Permits
The following forms are available for you to print and complete. In addition to parent input, some of the individual health care plans require completion by, and a signature from, a physician.
Contact your School Nurse if you have questions or concerns. Return the completed care plans to your school nurse as soon as possible.
The parent is responsible for informing the school of medical care that is needed and for completing the care plans.
Licensed health care providers’ orders are required for specialized health services such as Epi-pen injection, self administration of medications during school, blood glucose monitoring (insulin administration), gastrostomy tube feedings, clean intermittent catheterizations, nebulizer treatments, food allergies, etc.
Forms Available in English
- Allergic Reaction Parent-Physician Info 2020-21
- Asthma Parent-Physician Info 2020-21
- Administration of Medication Permit 2020-21
- Self Administer Medication Permit 2020-21
- Administration of Herbal Supplements at School, Authorization
- Consent for Release of Information 2020-21
- Diabetes Medical Management Plan 2020-21
- Diabetes Medical Management Plan Pump Supplement 2020-2021
- Diabetes Supply List Needed for School
- Nutrition Services Physician Letter 2020-21
- Guidelines for Accommodating Children with Special Dietary Needs
- Personal Health History 2020-21
- Immunization History
- School Dental Examination
- Seizures Parent-Physician Info 2020-21
- Sports Physical - Pre-participation Physical Evaluation
- School Entry Physical Exam
- Concussion Fact Sheet for Athletes
- Concussion Fact Sheet for Parents
- Concussion and SCA Acknowledgement Form
- Concussion Health Care Provider Return to Play Form
- Sudden Cardiac Arrest (SCA) Fact Sheet for Student Athletes
- Sudden Cardiac Arrest (SCA) Fact Sheet for Parents
Forms Available in Spanish
- Autorización para el suministro de medicacion en las escuela 2020-21
- Permiso para llevar medicamentos de emergencia 2020-21
- Aviso de Vacunacion Para Todos los Estudiantes 2019-20
- Nutrition Services Physician Letter 2020-21
- Examen dental de la escuela
- Expediente físico y de salud del estudiante
- Historial de Salud 2020-21
- Registro de vacunación
- Suministro de medicación en la escuela (Guía para los padres)