Clinic Forms

Medication Administration

If your child needs to take medication at school please fill out this form and bring to the clinic with the medication in its original container, with a pharmacy label if a prescription. Remember the policy is NO prescription medication can be brought to school by the student! 
Medical Authorization

Seizure Info and Action Plan

If your child has seizures please fill out this packet, have doctor sign and bring to school.
Seizure Packet - English

Asthma

If your child has Asthma and will need an inhaler or nebulizer treatment at school, please fill out this packet and bring to school with medication appropriately labeled and in its original container.
Asthma Packet

Allergy Action Plan

If your child has a food allergy, please have your child's physician complete the Allergy Action Plan. Physician documentation of life threatening food allergies is required by the United States Department of Agriculture before a food substitution can be made.
Allergy Packet- English

Release of Information

It may be necessary to speak or request information directly from your child's health care provider during the management of their health during the school day. This form allows Klein ISD to request and / or release confidential information. Please ensure this document is on file in the clinic.
Notice for Release / Consent to Request Confidential Information

It may be necessary to speak or request information directly from your child's healthcare provider during the management of their health during the school day. This form allows Klein ISD to request and / or thumb up confidential information. Make sure this document is on file at the clinic.
Notice of Transfer / Consent to Acquire Confidential Information