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Student Health Services Health Forms, Documents, Information


Health Forms

Authorization for medication administration:
This form is required for any medication, over the counter or prescription.

Medication administration form (Click here)
This form is needed for any type of medication whether it is prescription or over the counter.

This form must be signed by a physician and must be renewed each school year. A doctor of chiropractor is NOT acceptable.

Diabetes medical management plan:
Regardless of a student’s independence with their Diabetes, students will still need written orders on file in the health office in case of an emergency. The orders must also include an order for Glucagon.

Specialized health care services (parent request):
This form is used for two purposes. The first purpose is for students that are in our Special Education classes and who require assistance with activities of daily living.  The second purpose is for students that are not enrolled in special education however, need assistance with anything on an ongoing basis that does not otherwise have its own form.  Examples include: scoliosis braces or bathroom assistance during a broken appendage. A new form is completed each year.

Specialized health care services (physician order/request):
This form may accompany the above form if the service requires a physician’s order. If you are not sure whether or not you need a physician’s order, please contact the nurse at your child’s school. Download form in English and Spanish

Release of Information:
This form is needed when a member of the school will need to contact the physician for many different reasons. A couple of reasons include: correcting errors within physician’s orders in a timely manner or discussing certain procedures that are unclear in physician’s orders. This is very helpful for nurses when parents are having difficulty contacting their child’s provider.

English (PDF)| Spanish (PDF)

Developmental and Health History / Antecedentes de Salud y Desarrollo: This form is used for student’s that need to complete a recent health history for a triennial IEP or if the student has had a change in their health condtion. English and Spanish

Medical Management Form (Click here)
This is a generalized form and is used for any condition that we do not have a form already created for. Meaning, conditions other than: seizures, asthma, G tube feeding, or bee allergies. Examples of children who may need a medical management form: migraines, heart conditions, menstrual cramps, anxiety, fainting, high blood pressure. These forms may also be used in combination with someone that requires a special medication and further guidance for the health staff would be helpful.

If your child has a condition, please have the provider complete this form.

If your child does not have a health condition, and you received this form, please write” my child does not have a current health condition that requires attention while at school” and sign/date.

Asthma form
This form is needed to better manage the symptoms of an attack.

This form must be completed by a physician. This form should be updated each year or when your child’s asthma care changes.

If you do not see a form listed here or in the forms section, please email Margaret McLean: to obtain the correct form.


Medi-Cal Billing Information Letters English | Spanish

Communicable Diseases

COVID-19: California Department of Public Health

Pertusis (PDF): English (PDF)| Spanish (PDF)

Bed Bugs: English (PDF)| Spanish (PDF)

Chicken Pox: English (PDF)| Spanish (PDF)

CMV: English (PDF)| Spanish (PDF)

Emergency First Aid Guidelines (PDF)

Exclusion Policies School Control Measures (PDF)

Facts About Fifth Disease: English (PDF)| Spanish (PDF)

Hand, Foot Mouth Disease: English (PDF)| Spanish (PDF)

Impetigo: English (PDF)| Spanish (PDF)

Mono: English (PDF) Spanish (PDF)

Pinworms: English (PDF)| Spanish (PDF)

Scabiles: English (PDF)| Spanish (PDF)

Streptococcus Scarlet Fever: English (PDF)| Spanish (PDF)

Zika: The Basics of the Virus and How to Protect Against It (

Measles: The basics English (PDF) | Spanish (PDF)

Information regarding California health care for all children:

All In: Health Care for All Families

IMM-231 California Immunization Requirements Changes effective beginning in the 2019-20 school year.

Influenza-like Illness

Parent’s Guide to MRSA

What is Enterovirus D68?

Info for Students

All In: Health Care for All Families

IMM-231 California Immunization Requirements Changes effective beginning in the 2019-20 school year.

Influenza-like Illnesses

Neighborhood Health Care: Services and presentations on pregnancy prevention, preventive healthcare, medical screenings, HIV/STD education and prevention, guide to healthy relationships, and abstinence.

Preventing Youth Suicide

School Health Services Team

Margaret McLean MSN, RN, PHN
District Nurse
Phone: (760) 291-3007
Fax: (760) 741-1846

  • START Program
  • IEP Health Reports
  • 504
  • Staff Training (Medical team participant procedures & conditions)
  • Medical Procedure Compliance
  • IHP (Classroom health care plans)
  • Guidance for home hospital resource

School Health Services Staff

Escondido High School

Lisa Courduff LVN
Student Health Specialist
Phone: (760) 291-4080
Fax: (760) 741-1935

Health Office Clerk
Marissa Glaser
Phone: (760) 291-4081

Orange Glen High School

Leticia Gonzalez LVN
Student Health Specialist
Phone: (760) 291-5080
Fax: (760) 839-9270

Cynthia Martinez
Health Office Clerk
Phone: (760) 291-5081

San Pasqual High School

Caroline Akers, RN
Student Health Specialist
Phone: (760) 291-6080
Fax: (760) 745-1834

Health Office Clerk
Cindy Rippee
Phone: (760) 291-6081

Del Lago Academy

Marylou Villasenor RN
Student Health Specialist
Phone: (760) 291-2581
Fax: (760) 746-0453

Valley High School

Mon & Wed 8 – 12 pm
Phone: x2253