Health


Health Plan


Health Forms


Please print, complete and return Health Information Form to front office or Fax to front office at 368-8258 before the first day of school. If any boxes from Part 2 are checked except for vision and hearing please send a doctor note with explanation and treatment plan with health information form to ensure your child is getting the best care while at school.


Prescribing Licensed Provider must complete a separate Medication Order for each medication the student will be taking at school either daily or for emergencies. Also the parent or guardian must also sign the consent. There will be NO OTC (over the counter) medications given this school year 20-21. All medication orders are to complete in full and returned to the front office or faxed to 368-8258. Once all forms are returned to the nurse she will contact you on a day to bring in the medication which will have to have a current prescription label on each medication brought.


Please have Doctor complete this form.Parent or Guardian will also need to sign this form and return to the front office or fax to 368-8258. Please also fill out the Allergy Questionnaire form under the health tab to go along with this form. If the students allergy is to food please have their doctor complete the Food Service Form under the health tab so your child is not given or exposed to a food they are allergic to.


Please complete this form if your child has any allergies. Once completed and signed please return to the front office or fax to 368-8258.


Please have a doctor complete this form if your child has a Food Allergy, Diabetic, Hypoglycemic, PKU or other. Please return complete and signed documents to front office or fax to 368-8258.


Revised October 2019-*Louisiana State Law requires prior to school entry: 2 doses of MMR, 3 HepB, 2 VAR and booster doses of DTaP and Polio vaccines on or after the 4th birthday and prior to school entry. Sixth graders or 11-12 years of age are required: 1 Tdap, 2 VAR, 2 MMR, 3 HepB, 1 MenACWY. Effective 07/01/2019, eleventh graders or those 16 years of age will require 2 MenACWY.


9560 Highway 33
Farmerville, LA 71241

Fax: 318-368-8258

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This institution is an equal opportunity employer and provider.

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