Forms

Please find enclosed, common forms that you may find useful in communications with the school nurses of Penn Manor School District.

Health Profile for Students entering 3rd, 7th, and 9th grade

Physical Exam PA Department of Health

Medication Administration Form

Release of Information Form

Dental Exam Form PA Department of Health

Allergy Action Plan

Asthma Action Plan

Diabetes Care Plan

Special Dietary Needs for School Food Service (Revised August 2018)

Seizure Action Plan

Epinephrine Opt-Out Form

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