- Dublin City Schools
- Medical / Health Services Forms
Medication Forms
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5330 F5 Request for Administration of Emergency Seizure Medication
5330 F5 Request for Administration of Emergency Seizure Medication.pdf 201.42 KB (Last Modified on February 12, 2024) -
5330A E F1 Allergy and Anaphylaxis Emergency Orders and Action Plan
5330A E F1 Allergy and Anaphylaxis Emergency Orders and Action Plan.pdf 235.68 KB (Last Modified on June 14, 2023)
Allergy Forms
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5330A E F1 Allergy and Anaphylaxis Emergency Orders and Action Plan
5330A E F1 Allergy and Anaphylaxis Emergency Orders and Action Plan.pdf 235.68 KB (Last Modified on June 14, 2023) -
5335.01 F1 Parent-Guardian Information on Child's Life-Threatening Allergy
5335.01 F1 Parent-Guardian Information on Childs Life-Threatening Allergy.pdf 134.4 KB (Last Modified on September 5, 2023) -
8500 F1 Medical Statement for Special Diet Accommodations
8500 F1 Medical Statement for Special Diet Accommodations.pdf 172.22 KB (Last Modified on September 17, 2021)
Assisted Feeding Forms
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5335.02 F7 Parent Agreement for Gastrostomy-G Tube Reinsertion
5335.02 F7 Parent Agreement for Gastrostomy-G Tube Reinsertion.pdf 115.08 KB (Last Modified on September 5, 2023)
Asthma Forms
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5335 F1 Parent-Guardian Information on Child's Asthma
5335 F1 Parent-Guardian Information on Childs Asthma.pdf 157.54 KB (Last Modified on September 5, 2023)
Catheter Forms
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5330 C F1 Request for Clean Intermittent Catheterization by School Personnel
5330 C F1 Request for Clean Intermittent Catheterization by School Personnel.pdf 161.03 KB (Last Modified on June 14, 2023)
COVID Related Forms
Immunization Forms
Private Provider Forms
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3120.091 F3 Liability Release for Private Providers
3120.091 F3 Liability Release for Private Providers.pdf 133.31 KB (Last Modified on January 27, 2023)
Seizure Care Forms
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5330 F5 Request for Administration of Emergency Seizure Medication
5330 F5 Request for Administration of Emergency Seizure Medication.pdf 201.42 KB (Last Modified on February 12, 2024) -
5340 F5 Parent-Guardian Information on Child's Seizure Disorder
5340 F5 Parent-Guardian Information on Childs Seizure Disorder.pdf 175.24 KB (Last Modified on May 5, 2020)
TB Forms
Other Medical / Health Services Forms
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2340 F5 Chaperone Emergency Medical Authorization Form
2340 F5 Chaperone Emergency Medical Authorization Form.pdf 160.54 KB (Last Modified on January 13, 2023) -
2340C F1 District-Sponsored Overnight Trip Medical Authorization Form
2340C F1 District-Sponsored Overnight Trip Medical Authorization Form.pdf 216.7 KB (Last Modified on January 13, 2023) -
5310 F3 School Vision and-or Hearing Screening-Monitoring Waiver
5310 F3 School Vision and-or Hearing Screening-Monitoring Waiver.pdf 87.14 KB (Last Modified on June 14, 2023) -
5320 F5 Medical Provider Review and Determination of Parent Reported Varicella
5320 F5 Medical Provider Review and Determination of Parent Reported Varicella.pdf 133.74 KB (Last Modified on June 14, 2023) -
8330 F4a Parent Consent for Record Release Form-English
8330 F4a Parent Consent for Record Release Form-English.pdf 183.19 KB (Last Modified on October 24, 2023) -
8431 F2 Advisory of Pesticide Application in Classroom Buildings
8431 F2 Advisory of Pesticide Application in Classroom Buildings.pdf 79.77 KB (Last Modified on May 5, 2020)
Arabic Forms
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8330 F4a Parent Consent for Record Release Form-Arabic
8330 F4a Parent Consent for Record Release Form-Arabic.pdf 188.77 KB (Last Modified on October 24, 2023)
Chinese Forms
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8330 F4a Parent Consent for Record Release Form-Chinese
8330 F4a Parent Consent for Record Release Form-Chinese.pdf 223.34 KB (Last Modified on October 24, 2023)
Japanese Forms
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8330 F4a Parent Consent for Record Release Form-Japanese
8330 F4a Parent Consent for Record Release Form-Japanese.pdf 213.22 KB (Last Modified on October 24, 2023)
Korean Forms
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8330 F4a Parent Consent for Record Release Form-Korean
8330 F4a Parent Consent for Record Release Form-Korean.pdf 226.81 KB (Last Modified on October 24, 2023)
Spanish Forms
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8330 F4a Parent Consent for Record Release Form-Spanish
8330 F4a Parent Consent for Record Release Form-Spanish.pdf 194.49 KB (Last Modified on October 24, 2023)