Roseville City School District

Medication Forms

Medications At School

A student who requires medication during the course of the school day must have written permission from both his/her parent or guardian and physician, detailing the medication, method of administration, amount, and time it is to be given.

Parents/Guardians must bring the medication to the school office in its original container, with the correct dosage, administration information, and student’s name printed on the label.

A new medication form must be completed each school year.

Medication forms can be accessed for each school site (see links below). All medication forms are also available in the school office.

Mandated Health Screenings

Per California State Law, school nurses coordinate mandated screenings for the following grade levels:

  • Vision K, 2, 5, 8
  • Hearing K, 2, 5, 8
  • Color Vision K boys only

If your child does not pass one of the above screenings, a referral will be sent home.

Physical Health Examination (CHDP) Requirement

To protect the health of children, California law requires that students receive a health assessment within 18 months prior to a student beginning their first grade year. Roseville City School District requires that this is completed in the Kindergarten year. Please complete the health exam report (below) with a health examiner and return it to the school. 

Health Examination for School Entry - English/Spanish

WAIVER of Health Examination for School Entry - English/Spanish

Oral Health Form

Effective January 1, 2007, students in their first year of a public school must submit proof of oral health assessments. The assessments must be performed by a licensed or registered dental health professional, and proof of assessment is due on an annual basis by May 31.

Oral Health Assessment - English
Formulario de evaluación de la salud bucal - Español