Clinic Forms

Entering PWCS for the first time:

School Entrance Physical Form (PDF)- This form is required for any incoming Kindergarten students as well as any student coming in to PWCS for the first time.

Tuberculosis Screening (English)
Tuberculosis Screening (Spanish) (PDF)
This regulation will provide you the forms required for any incoming Kindergarten students as well as any student coming in to PWCS for the first time.

Medication and Management of Chronic Illness:

Virginia Asthma Action Plan (PDF)- This form is required for any student who has a diagnosis of Asthma. This form is required to administer inhalers to students.

Seizure Action Plan (PDF) - This form is required for any student who has a diagnosis of epilepsy or seizure disorder. This form is required to administer emergency medication.

Medication Administration Form (English)
This form is required to give ANY medication to a student (prescription or over-the-counter).

Diabetes Medical Management Plan
This regulation will provide the necessary forms for any student diagnosed with Diabetes.