• The following are a list of medical forms to be completed by a parent/guardian; please note that some forms require a physician's signature. All students who have a medical condition should complete a student individual emergency medical plan. Additional forms are required for special diets (i.e. no pork, soy allergy, etc.), diabetes, siezures, severe allergies, and asthma. Medication forms must be completed on all prescribed and OTC (over-the-counter) medications in order for the nurse to administer the medication to your child. Please note that students are not allowed to carry medications on campus. Exceptions are those who have completed the self carry medication form. Any student found to have medications in their possession will be sent to the nurse's office and a parent or guardian will be notified. Please refer to the student handbook in regards to medications on campus. If you have any questions or concerns please feel free to contact me by email at Kimberly.Reichert@dvusd.org.

      Student Individual Emergency Medical Plan (all students with a medical condition) Requires a physician's signature

      Parent Authorization Release of Information

      Anaphylaxis-Emergency Plan Requires a physician's signature

      Diabetes Requires a physician's signature

      Asthma Requires a physician's signature

      Medication Form (prescribed and over the counter) Requires a physician's signature

      MAR Log (medication administration record)


      Severe Allergy History Form