Medical Forms & Documents

General Consent to Bill Medicaid and FAMIS for All Students

General Consent to Bill Medicaid and FAMIS for All Students 2023.docx.pdf 74.54 KB (Last Modified on July 26, 2023)

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Allergy and Anaphylaxis Emergency Plan

AAP_Allergy_and_Anaphylaxis_Emergency_Plan.pdf 198.89 KB (Last Modified on August 18, 2020)

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Asthma Action Plan - PDF

va-asthma-action-plan-2020.pdf 162.69 KB (Last Modified on April 8, 2022)

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Asthma Action Plan - RTF

va-asthma-action-plan-2020.rtf 48.59 KB (Last Modified on April 8, 2022)

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Asthma Self Carry Contract - PDF

CHP5-F9_Asthma_Inhaler_Contract - PDF Fillable.pdf 77.40 KB (Last Modified on February 23, 2017)

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Asthma Self Carry Contract- RTF

CHP5-F9 Asthma Inhaler Contract - RTF Fillable.rtf 10.52 KB (Last Modified on April 23, 2019)

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Diabetes Medical Management Plan (DMMP) - Virginia

diabetes-medical-management-forms.pdf 889.59 KB (Last Modified on April 11, 2022)

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Diabetes Medical Management Plan (DMMP) Supplement - Virginia

Schools VDC DMMP Suppplement Rev 5 2020.pdf 121.56 KB (Last Modified on October 30, 2020)

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Medication Permission - PDF

CHP6 F9 Medication Permission Revised March 2018.pdf 167.58 KB (Last Modified on April 18, 2019)

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Parent Letter About Food Allergies & School Nutrition - PDF

Allergy Letter to Parent Summer 2014.pdf 35.59 KB (Last Modified on August 30, 2016)

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Parent Letter About Food Allergies & School Nutrition - RTF

Allergy Letter to Parent Summer 2014.rtf 4.77 KB (Last Modified on April 24, 2019)

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Physician's Statement for Students with Special Dietary Needs at School - PDF

CHP7-F1 Diet Prescription for Meals at School.pdf 10.43 KB (Last Modified on August 30, 2016)

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Physician's Statement for Students with Special Dietary Needs at School - RTF

CHP7-F1 Diet Prescription for Meals at School.rtf 23.56 KB (Last Modified on April 24, 2019)

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Scoliosis Facts For Parents - PDF

CHP3-F7 Scoliosis Facts for Parents.pdf 386.92 KB (Last Modified on March 1, 2019)

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Scoliosis Facts For Parents - RTF

CHP3-F7 Scoliosis Facts for Parents.rtf 5.21 KB (Last Modified on April 24, 2019)

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Seizure Action Plan - PDF

GENERAL_Seizure_Action_Plan_2020_April7_FILLABLE.pdf 248.42 KB (Last Modified on April 11, 2022)

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Seizure Acton Plan - RTF

GENERAL_Seizure_Action_Plan_2020_April7_FILLABLE.rtf 115.94 KB (Last Modified on April 11, 2022)

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Severe Allergy Anaphylaxis Care Plan - PDF

6_b_PD16__Anaphylaxis_Care_Plan_2014 - PDF Fillable.pdf 275.91 KB (Last Modified on February 23, 2017)

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Severe Allergy Anaphylaxis Care Plan - RTF

6 b PD16 Anaphylaxis Care Plan 2014 - PDF Fillable.rtf 31.77 KB (Last Modified on April 24, 2019)

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Spanish Scoliosis Facts For Parents - PDF

Scoliosis Facts for Parents Spanish.pdf 288.59 KB (Last Modified on March 1, 2019)

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Spanish Scoliosis Facts for Parents - RTF

Scoliosis Facts for Parents Spanish.rtf 5.32 KB (Last Modified on April 24, 2019)

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Spanish TDAP Fact Sheet - PDF

Spanish TDAP.pdf 287.87 KB (Last Modified on March 15, 2017)

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Spanish TDAP Fact Sheet - RTF

Spanish TDAP.rtf 240.79 KB (Last Modified on April 23, 2019)

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TDAP Fact Sheet - PDF

TDAP.pdf 281.41 KB (Last Modified on March 15, 2017)

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TDAP Fact Sheet - RTF

TDAP English.rtf 203.48 KB (Last Modified on April 23, 2019)

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Enrollment Forms

English

Admissions, Residency, and Attendance Required Admission and Registration Credentials for Students

2022 Admissions.pdf 200.11 KB (Last Modified on March 28, 2022)

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Adolescent Consent Form- English

2022 Adolescent Consent Form English.pdf 357.76 KB (Last Modified on April 26, 2022)

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Enrollment Requirements (Proof of Residency) 22/23 SY

Enrollment_Requirements_Proof_Of_Residency_March 2023_Accesible.pdf 442.38 KB (Last Modified on March 16, 2023)

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School Entrance Health Form MCH-213G

MCH213G_School_Entrance_Fillable-Form.pdf 535.98 KB (Last Modified on January 24, 2023)

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School Entrance Health Information (Health History)

CHP2-F3 School Entrance Health Information 2021 Updated 4282021.pdf 92.49 KB (Last Modified on April 28, 2021)

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TB Risk Assessment Form

TB Risk Assessment for students 2015 - PDF Fillable.pdf 194.45 KB (Last Modified on February 23, 2017)

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Stafford County Public Schools

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Medical Forms & Documents

General Consent to Bill Medicaid and FAMIS for All Students

Allergy and Anaphylaxis Emergency Plan

Asthma Action Plan - PDF

Asthma Action Plan - RTF

Asthma Self Carry Contract - PDF

Asthma Self Carry Contract- RTF

Diabetes Medical Management Plan (DMMP) - Virginia

Diabetes Medical Management Plan (DMMP) Supplement - Virginia

Medication Permission - PDF

Parent Letter About Food Allergies & School Nutrition - PDF

Parent Letter About Food Allergies & School Nutrition - RTF

Physician's Statement for Students with Special Dietary Needs at School - PDF

Physician's Statement for Students with Special Dietary Needs at School - RTF

Scoliosis Facts For Parents - PDF

Scoliosis Facts For Parents - RTF

Seizure Action Plan - PDF

Seizure Acton Plan - RTF

Severe Allergy Anaphylaxis Care Plan - PDF

Severe Allergy Anaphylaxis Care Plan - RTF

Spanish Scoliosis Facts For Parents - PDF

Spanish Scoliosis Facts for Parents - RTF

Spanish TDAP Fact Sheet - PDF

Spanish TDAP Fact Sheet - RTF

TDAP Fact Sheet - PDF

TDAP Fact Sheet - RTF

Enrollment Forms

English

Admissions, Residency, and Attendance Required Admission and Registration Credentials for Students

Adolescent Consent Form- English

Enrollment Requirements (Proof of Residency) 22/23 SY

School Entrance Health Form MCH-213G

School Entrance Health Information (Health History)

TB Risk Assessment Form

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