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Health Inventory forms
This is a general form for parents to notify us of any medical conditions for their students.
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Health Inventory Form (Required)
Every CVHS student will need to complete this form upon enrollment.
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Medication Administration Form (If needed)
This form is for students who will need to take medication during school hours. One form for each medication (even if it is an over-the counter medication) is required. It must be filled out by a healthcare provider.
**For over-the counter medication*** Your student's healthcare provider must write a prescription for the medication, and it must be filled by a pharmacy so it has a pharmacy label on it. Even for common medications like Benadryl, Ibuprofen, and Tylenol.
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Medication Administration by Student Form (If needed)
This form is needed if your student plans to carry an epi-pen, inhaler, or other life-saving emergency medication in their backpack. I also recommend keeping emergency medication in the clinic as well. This form must be filled out by a healthcare provider.
Medication_Administration_Form_Self_Carry_rev_08-2018.pdf 135.15 KB (Last Modified on April 30, 2021) -
Asthma Action Plan (If needed)
An asthma action is needed for every student who has asthma. The form must be filled out by a healthcare provider and turned into the nurse.
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Seizure Emergency Plan (If needed)
This form is needed for students who have seizures. It must be filled out by a healthcare provider.
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Food Allergy & Anaphylaxis Emergency Plan (If needed)
This form is needed for all students who have a severe food allergy. It must be completed by a healthcare provider.
Food_Allergy_-_Anaphylaxis_Plan_Acion_Plan_E_-_S_17-18.pdf 402.17 KB (Last Modified on April 30, 2021) -
Dietary Accomodations Form (If needed)
If your student needs dietary accommodations, your family healthcare provider can fill this out to specify what is needed.
Physician Request for Dietary Accommodations Form.pdf 1,012.08 KB (Last Modified on February 7, 2022)
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- A Health inventory form is needed for each student upon enrollment.
- The Medication Administration form is for students who will need to take medication during school hours. Your student's healthcare provider must write a prescription for the medication, and it must have a pharmacy label, even for over-the-counter medication.
- The Self-Carry Medication Form is needed if your student plans to carry an epi-pen or inhaler. I also recommend keeping emergency medication in the clinic as well. This form must be filled out by a healthcare provider.
- An Asthma Action Plan is needed for every student who has asthma. The form must be filled out by a healthcare provider and turned into the nurse.
- A Seizure Emergency Plan is needed for students who have any kind of seizure disorder. It must be filled out by a healthcare provider.
- A Food Allergy & Anaphylaxis Emergency Plan is needed for all students who have a severe food allergy. It must be completed by a healthcare provider.
- A Dietary Accommodations Form is needed if your student requires any dietary accommodations, your family healthcare provider can fill this out to specify what is needed.
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Houston ISD Health and Medical Services Website
Here you will find shortcuts to everything your student will need regarding health and medical services.