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Loudoun School Forms

Health Forms for registration:

Commonwealth of Virginia School Entrance Health Form

Tuberculosis Screening

Religious Exemption for Immunizations 

 

Health Forms for medical needs:

Allergy Action Plan/Health Care Plan

Authorization for Medication Administration

Asthma Action Plan/Health Care Plan

Diabetes - Virginia Diabetes Medical Management Plan
part 1 completed by parents,
part 2, 3, and 4 completed by the physician

Restricted Activities checklist

Seizure Physician's Orders/Health Care Plan

Physician Order for Individual Health Care Plan

Physician's Order for Gastrostomy Tube Feeding

Physician's Order for a Concussion