Student Support Services
Health Tech
SSontag@pleasantvalleysd.org
805-482-4608 Fax 805-512-8149
Preschool Physical Exam
Form for Doctor to fill out in order to have Medication at School
Must have this form and the Medication Authorization form to have an EPI Pen kept on Campus
Second form that must be filled out by Doctor for students with Asthma.
You must also turn in Medication Authorization Form
Parent fill out and Admin approves. Doctor must check the box on the Astma Care Plan that "States Student may care own Inhaler"
Must be fill out by Doctor prior to reurn to school after an Injury
Must have a note from Doctor
