Health Information & Forms
Health Information & Forms
Each school year and whenever there is any change in medicine, instructions or doctor,, parents or legal guardians must provide new, updated forms (California Education Code Section 49423, 49423.1). Please download the forms that are relevant to your child and complete them, or have your physician complete them as directed. Please return the completed forms to your student’s Assistant Principal.
Please Note: There is no school nurse on site on a daily basis.
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- CIF Graded Concussion Symptoms Checklist
- CIF Graded Concussion Symptoms Checklist(Español)
- Concussion Physician Letter to School
- Concussion Physician Letter to School (Español)
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If your child needs to take medication during school hours, fill this form out with your healthcare provider and deliver it to the school.
Medications must be picked up at the end of each school year. This form must be renewed annually.
Medication must come to the front office with form completed and signed by parent/guardian and healthcare provider, and:- be properly labeled in a bag with student's name and grade
- in original container with expiration date
- prescription medications must have name/telephone of pharmacy, student's name, and name and phone number of healthcare provider
- Authorization for Medication Form
- Authorization for Medication Form (Spanish)
- Authorization For Student To Carry & Self Administer Medication In School
- Authorization For Student To Carry & Self Administer Medication In School (Español)
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Staff, Students, and Community Members can submit a referral form via the MVLA Student Support Referral Forms.
Types of Student Support Requests are supported through this Referral Form
- Academic Stress
- Personal Issues
- Emotional Issues
- Social Issues
- Physical Issues
- Social Services
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If your child needs to have emergency anti-seizure medication available at school, have both of these forms filled out and deliver them to the school.
Medications must be picked up at the end of each school year.
These forms must be renewed annually.
Medication must come to the front office with form completed and signed by parent/guardian and healthcare provider, and:- be properly labeled in a bag with student's name and grade
- in original container with expiration date
- prescription medications must have name/telephone of pharmacy, student's name, and name and phone number of healthcare provider
Please provide a Seizure Action Plan to the school with your student's emergency anti-seizure medication.
- Seizure Action Plan
- Seizure Action Plan (Español)
- Seizure Questionnaire for Parents
- Seizure Questionnaire for Parents (Español)
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HEALTH ALERT!
Fentanyl: A Powerful, Synthetic Opioid. 50 Times Stronger Than Heroin And 100 Times Stronger Than Morphine. Fentanyl Is A Major Factor In Both Fatal And Non Fatal Overdoses In Ca And The U.S.
Resources To Address Fentanyl Use And Prevention:
- Fentanyl Crisis Among California’s Youth: Presentation created by "The Statewide Alliance for Safe Schools" on September 28, 2022
- CDPH Videos
- CDPH Overdose Prevention Initiative
- CDPH Fentanyl web page
- Instructional Resources
- One Pill Can Kill - Fentanyl Resources from US Drug Enforcement Administration
- What is Fentanyl? - CDC resources