Required and Recommended Health Forms

Health Requirements:

Overview of Health Requirements

Immunization Requirements 

Without an immunization record, your student cannot start school, and will be excluded until the school receives an Iowa Health and Human Services (HHS) approved record.

The record of immunization requirement may be met through submission of an approved:

• Iowa HHS completed immunization record
• Iowa HHS religious exemption record or
• Iowa HHS medical exemption record signed by a prescribing doctor specifying that the immunizations required would be injurious to the student or to any household member.

(Exemptions do not apply when the Iowa Council of Health and Human Services has determined and the Director of Iowa Health and Human Services has declared an emergency or epidemic exists.)

Physical Form

Athletic Physical Form (7th-12th Grade)

Certificate of Dental Screening (Kindergarten & 9th grades)

Certificate of Vision Screening (Kindergarten & 3rd grades)

Medical Forms:

Allergy-Anaphylaxis Action Plan

Asthma Action Plan

Diabetes Medical Management Plan

Seizure Action Plan

Diet Modification Request Form

Medical Certificate of Immunization Exemption

Religious Certificate of Immunization Exemption

Medications:

Medication Administration Policy

Medication Self-Administration Authorization – Inhaler/Epi-Pen

Medication Permission and Intake Form