School District Forms
Anaheim City School District Forms ACSD State Preschool Physical Exam ACSD State Preschool Physical Exam-Head Start Authorization for Use and Disclosure of Health Information Dental Screening Referral Emergency Medication Self-Administration Action Plan Fifth Disease Exposure Notice First Aid Follow-Up Instructions Hearing Referral (English and Spanish) Head Start in ACSD pamphlet Individualized Health Care Plans summarized Kindergarten Registration Information OCDE Medication Request-English OCDE Medication Request-Spanish Physician's Request for Special diet Report of Vision Screening Self-Administration of Insulin with Observation Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.acsd.k12.ca.us January, 2006. Centralia School District Forms CESD State Preschool Programs brochure-English CESD State Preschool Programs brochure-Spanish Danbrook Neighborhood Resource Center Clinic-English Danbrook Neighborhood Resource Center Clinic-Spanish HIPAA Privacy Authorization for Realease of Information-English HIPAA Privacy Authorization for Realease of Information-Spanish OCDE Medication Request-English OCDE Medication Request-Spanish New Student Registration Information-English New Student Registration Information-Spanish Physician's Order for treatment-Asthma Emergency Protocol Physician's Report-Child Care Centers Health Evaluation Physician's Report Project Bright Start Brochure-English Project Bright Start Brochure-Spanish Project E I E I O brochure-English Project E I E I O brochure-Spanish Referral for Asthma Evaluation Report of Health Appraisal-Hearing (English & Spanish) Report of Medical Referral Report of Vision Screening-English Report of Vision Screening-Spanish Seizure Disorder Update (Parents and Physicians) State Preschool Programs Registration the School-Based Health Care Center brochure Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.cesd.k12.ca.us . March, 2006.
Huntington Beach City School District Forms Authorization for Use or Disclosure of Health Information to and from School Districts Emergency Medication Self-Administration Action Plan First Aid Follow-Up Instructions Hearing Referral (English and Spanish) OCDE Medication Request - English OCDE Medication Request - Spanish Physician's Report-Child Care Centers Health Evaluation Report of Health Examination for School Entry - English and Spanish Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.hbcsd.k12.ca.us. August, 2006.
La Habra City School District School Forms Asthma Action Plan Request for Medication, English Request for Medication, Spanish Request for Medication, Vietnamese Report of Health Examination for School Entry Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.lhcsd.k12.ca.us . June, 2007 Newport-Mesa Unified School District Forms Asthma Action Plan-Peak Flow Monitoring Authorization for Use or Disclosure of Medical or Educational Information-English Authorization for Use or Disclosure of Medical or Educational Information-Spanish Handout for Hope Healthy Start Program Medical Referral for Emergency Care or Routine Evaluation-English Medical Referral for Emergency Care or Routine Evaluation-Spanish Message From Your School Nurse-English Message From Your School Nurse-Spanish Management of Diabetes at School OCDE Medication Request-English OCDE Medication Request-Spanish Physician's Report-Child Care Centers Health Evaluation Preschool Student Registration Information-English Preschool Student Registration Information-Spanish Report of Health Examination for School Entry-English & Spanish Student Registration Information-English Student Registration Information-Spanish Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.nmusd.k12.ca.us. September, 2005.
Ocean View School District forms for Physician's office Authorization for use and/or disclosure of medical and/or educational information (english) Consent to exchange information and release of records (Eng/Span) Physician's report (Child's pre-admissions health evaluation) Medical referral-Physician's report Hearing examination report (Eng/Span) Vision examination report (Eng/Span) Immunizations report (Eng/Span) Oak View inter-agency collaberative referral form Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.ovsd.k12.ca.us. January, 2007
Orange Children and Parents Together (Head Start-Orange) OCTP Dental Form 2007 OCTP Flyer OCTP Health Referral OCTP Inadequate Immunization: English OCTP Physical Exam Form OCTP Physician's Request for Administration of Medication OCTP Vision and Hearing Screening Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.ocpt.org. February, 2007
Orange Unified School District Forms Management of Diabetes Authorization Parent and Physician Request for Medication- Spanish Parent and Physician Request for Medication- English Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.orangeusd.k12.ca.us/. February, 2007
Placentia-Yorba Linda Unified School District Forms Allergy Action plan-Peak Flow Monitoring Doctor's Form-Release For School Activities OCDE Medication Request Form-English OCDE Medication Request Form-Spanish Physician's Order for Tracheostomy Suctioning at School Report of Health Examination for School Activities- English/Spanish Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.pylusd.k12.ca.us. September, 2006
Santa Ana Unified School District Request for Medication, English Request for Medication, Spanish Request for Medication, Vietnamese Authorization for Release of Medical Information and Records Individual Healthcare Service Plan-Anaphylaxis Individual Healthcare Service Plan-Convulsive Disorder Individual Healthcare Service Plan-Genera Individual Healthcare Service Plan-Shunt Failure Asthma Action Plan Report of Medical Referral Special Medical Request Report of Vision Appraisal, English Report of Vision Appraisal, Spanish Request for Assessment / Services, English Request for Assessment / Services, Spanish Report of Health Examination for School Entry, English and Spanish Disclaimer: This list of forms is not inclusive. Other forms may be available through the school district website: www.sausd.k12.ca.us September, 2007.
Presentations
Clinical Focus Jack & Jill Can't Get Up the Hill, April 25, 2005 Pediatric Dental Screens: Healthy Smiles for Kids, February 8, 2006 Otoscopy/Diagnosis & Management of Otitis Media, April 25, 2005 Childhood Rashes, April 6, 2006 The Basics about Pediatric Heart Disease Diabetes Management in the School Setting Asian and Pacific Islander Health Issues Developmental Focus Brigance Follow-Up Lecture December 15, 2005 Development of Language and Communication, March 10, 2005 Developmental Screening Lecture, February 16, 2006 Lack Of Developmental Progress, March 10, 2005 Community Related/Other Focus AED Risk Assessment, January 24, 2006 Community Collaboration Partnering with the Health Care Community, October 28, 2005 Creating Your First Power Point Presentation, December 15, 2005 NCE Atlanta
