Medication Forms

Roseville City School District
Overview

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.

The medication must be brought 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 via the links below and are available in the school office.

Blue Oaks - Form 67 - Parent Physician Release for Medication in School
Brown - Form 67 - Parent Physician Release for Medication in School
Buljan MS - Form 67 - Parent Physician Release for Medication in School
Chilton MS - Form 67 - Parent Physician Release for Medication in School
Cirby - Form 67 - Parent Physician Release for Medication in School - Auto Fill 2.17
Cooley MS - Form 67 - Parent Physician Release for Medication in School
Crestmont - Form 67 - Parent Physician Release for Medication in School
Diamond Creek - Form 67 - Parent Physician Release for Medication in School
Eich MS - Form 67 - Parent Physician Release for Medication in School
Fiddyment Farm - Form 67 - Parent Physician Release for Medication in School
Gates - Form 67 - Parent Physician Release for Medication in School
Junction - Form 67 - Parent Physician Release for Medication in School
Kaseberg - Form 67 - Parent Physician Release for Medcation in School
Orchard Ranch - Form 67 Parent Physician Release for Medication in School
Sargeant - Form 67 - Parent Physician Release for Medication in School
Spanger - Form 67 - Parent Physician Release for Medication in School
Stoneridge - Form 67 - Parent Physician Release for Medication in School
Thomas Jefferson - Form 67 - Parent Physician Release for Medication in School
Woodbridge - Form 67 - Parent Physician Release for Medication in School

Mandated Health Screenings

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

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

Physical Health Examination (CHDP) Requirement

Within 90 days after a child’s entrance into 1st grade, state law requires that parents submit a certificate of health examination and screening documenting a physical examination within the past 18 months.

Oral Health Assessment

Effective January 1, 2007, students in their first year in 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.