Student Health Forms
Student health forms are used to assist in health planning for students. The nursing staff, educational team, and family need input and instructions from the health care provider to ensure that students are provided the necessary support while in the care of the school. If your student requires a 504 plan or IEP to be successful in school, student health forms may be required. If you are seeking hospital homebound services, please complete and submit the Referral for Homebound Services Packet (Click to download). All forms must be completed and signed by a physician. Please review before submitting any health forms to your school, and take note that some forms also require a parent/guardian's signature. Completed Medical Packets (click to download) will remain in effect for one school year, and a new set of documents are required each August before the start of school and/or anytime there is a change to the student’s medical status. If new orders are not received, parents have the right and responsibility to administer medications and/or perform special health procedures during the school day.
Health Screening Forms: Scoliosis
What is scoliosis?
- Scoliosis is a sideways curve of the spine. About 3% of children are affected by scoliosis. It can occur at any age but is often noticeable between the ages of 9 and 16, when growth occurs rapidly.
- Early detection is important to avoid potentially serious problems later in life if a spinal curve is not recognized, or treated, and it continues to progress.
How can my child be screened for scoliosis?
- The screening test is an observation of the child’s back when standing and bending forward.
- There are options for how the screening can be completed:
- Submit a completed Form #4400, Certificate of Scoliosis screening (click to download form). Form #4400 can be completed by a physician with an active GA license or person working under the supervision of a physician with an active GA license, the local health department, or a licensed school nurse. A completed Form #4400 should be provided to the school within the first 90 days of 6th and 8th grade.
- OR your child can participate in a school scoliosis screening event*. Students without a completed Form #4400 on file more than 90 days after the start of school will be asked to participate in scoliosis screening during a school screening event.
Scoliosis forms and letters available to download:
- Form #4400, Certificate of Scoliosis screening
- Form #4400 in Spanish, Certificado de prueba de detección de escoliosis
- Parent Scoliosis Letter (English and Spanish)
- Scoliosis Screening Instruction Sheet - CHOA_DPH
*Our school nurses are governed by the Georgia Nurse Practice Act and APS Policy JGCD – Medication, and they will only administer medication in accordance with written medical orders signed by a licensed physician, dentist, or podiatrist. APS nurses will not modify any dosage of medicine based solely on a request or recommendation by a parent or guardian. A parent or guardian seeking a dosage modification must provide the nurse with an appropriate medical order.