Health Forms

If your child is accepted into the program, he/she will not be able to start school without current health paperwork completed and return to school.

  • Completed physical (including growth assessment, blood pressure and immunizations)
  • Current Dental Exam(Including a cleaning and fluoride) 
  • Blood Lead Results
  • Hemoglobin/Hematocrit Results 
  • Virginia Asthma Action Plan signed by the doctor(as needed) 
  • Food Allergy & Anaphylaxis Emergency Care Plan signed by doctor (as needed) 
  • FCPS Medical Authorization for Special Dietary Needs signed by doctor (if your child has dietary needs.) 
  • Unified School Medication Request Form signed by doctor (as needed)
  • Tuberculosis screening signed by the doctor (as needed) 

Dietary needs form

Physical Form

Dental Form

Child Tuberculosis Risk Assessment Form

Lead screen form

Emergency Health Care Plan

Unified School Medication Request Form

4-20-18 virginia asthma action plan

Food allergy and anaphylaxis emergency care plan

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