School Health Forms

The school district recognizes that it is necessary to have medication given to students during regular school hours, and we are prepared to assist in that need. It is preferable; however, if you and your health care provider can arrange the giving of medication on a schedule outside of school hours. You or your designee may come to school to administer medication to your child on a scheduled basis arranged with the school. 

With the exception of asthma inhalers, insulin, glucagon, and epinephrine auto-injectors (EpiPens), students are not permitted to carry prescribed OR over-the-counter medications on their person; medication must be kept in the health office.

Please make sure to review the Medication at School Guidelines before submitting a form

Medication At School Form/ Formulario de Medicamentos En La Escuela 

Seizure Response/Medication Form

Diabetes Medical Management Plan (DMMP)

The chronic illness form is geared towards students who may miss school due to chronic illness symptoms. These symptoms may not warrant an office visit, but might require the child to stay home from school. 

Please read over the instructions carefully; this form must be completed by a physician and submitted annually to the school.

Chronic Illness Verification Form/Forma de Enfermedad Cronica

In the Placer Union High School District, students are required to complete two years of physical education in order to graduate from high school.  A request for Physical Education Accommodations can be submitted for a valid medical reason accompanied by a physician’s verification.  Accommodations do not exempt students from Physical Education class.  The Physical Education Department would like to work with you to find the correct placement for your patient in our curriculum.  Please view the form for more information.

PUHSD PE Accommodation Form/ PE Formulario De Alojamiento