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Central Lyon CSD

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Health Forms/Requirements

 

HEALTH FORMS - ALL STUDENTS

*All health forms should be submitted directly to the office or by email to schoolnurse@co.lyon.ia.us

Health Registration Form

Medication Authorization Form (For medications brought from home to be given at school)

Immunization Requirement Table 

       Immunization Requirements (Iowa Department of Public Health version)

 

ADDITIONAL HEALTH FORMS

*To be completed by medical providers. All health forms should be submitted directly to the office, faxed to 712-472-2346 or emailed to schoolnurse@co.lyon.ia.us

Allergy & Anaphylaxis Emergency Plan

Asthma Action Plan

Authorization to Carry Inhaler 

Certificate of Dental Screening - Required for Kindergarten and 9th Grade. To be completed by dentist.

Certificate of Vision Screening - Required for Kindergarten and 3rd Grade. To be completed by eye doctor. 

Diet Modification Form

Diabetes Medical Management Plan

Seizure Action Plan

 

ATHLETIC FORMS

*Athletic forms need to be submitted to the office or coaching staff

Athletic Physical

Heads Up Concussion