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St. Helena Unified School District

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Health

Medical Forms

Medication Forms:
 If your child needs to take medication during school hours, fill out the form below with your healthcare provider and deliver it to the school.  This form must be renewed annually.  

Medication Authorization Form English Spanish

Medications must be picked up at the end of each school year. Medication must come to the front office with form completed and signed by parent/guardian and healthcare provider, and:

  • be properly labeled in a bag with the student's name and grade
  • in original container with expiration date
  • prescription medications must have the name/telephone of the pharmacy, the student's name, and name and phone number of the healthcare provider.

Emergency Health Plan Forms:

Allergy/Anaphylaxis Action Plan English Spanish
Asthma Action Plan English Spanish
Seizure Action Plan English Spanish

Release of Information Forms:

Kaiser Permanente English Spanish
Napa County SELPA English Spanish

 

Immunization Requirements

 

 

Concussion Resources

A cartoon illustration of a person experiencing a headache, with a visible brain and radiating lines.

English

Spanish

 

CIF Return to Learn, (Spanish)

CIF Return to Play, (Spanish)

 

Diabetes Information

A triangle with an orange border and a blue background, depicting a hand with a drop of blood, and the word 'Diabetes' below.

Type 1 Diabetes

Parent information (CA Ed Code Section 49452.6)                          

Type 2 Diabetes  

Parent Information (CA Ed Code Section 49452.7)

Assistive Devices

International Symbol of Access, a stylized stick figure in a circle with dots.

Use of Crutches, Walkers or Wheelchairs in School

English

Spanish