Health Services
Welcome and thank you for visiting Avon Public Schools Health Services. Health Services provides a number of forms and publications for Avon families.
IMPORTANT DOCUMENTS & FORMS
Below you will find a variety of important documents and forms for your convenience. Forms are designed to be printed and signed by hand before returning to the school. Documents can be viewed online or downloaded. If you need assistance with any of these documents or forms please contact your school nurse.
- administration of epinephrine for emergency first aid
- allergy management plan
- Concussion Education Plan and Guidelines for Connecticut Schools
- Early Childhood Health Assessment Record
- Health Assessment Record
- HIPPA FORM
- Husky A and Husky B (English)
- Husky A and Husky B (Spanish)
- Immunization Requirements 2019-2020
- Medical Authorization Form
- Medical Exemption Certification
- NASN guidelines for keeping a sick child home
- oral health screening (revised july 2018)
- Religious Exemption Statement
administration of epinephrine for emergency first aid
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About:
Connecticut law requires the administration of EpiPens to students in emergency situations. This REFUSAL form is a written directive from the parent/guardian for the EpiPen not to be administered to their child. Form is valid for the 2018-2019 school year.
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Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
allergy management plan
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About:
An outline of responsibilities that explains what is needed to determine a student's condition and a student's individualized care plan.
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Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Concussion Education Plan and Guidelines for Connecticut Schools
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About:
This document provides accurate information, resources and guidance needed to implement school district concussion education plans.
Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Early Childhood Health Assessment Record
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About:
State of Connecticut Department of Education Health Assessment Record for children ages birth - 5. (FORM-yellow)
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Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Health Assessment Record
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About:
State of Connecticut Department of Education Health Assessment Record for Kindergarten to 12 grades as well as sports participation. (FORM-blue)
Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
HIPPA FORM
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About:
Avon Public Schools HIPAA-compliant authorization form for the exchange of health and education information. (FORM)
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Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Husky A and Husky B (English)
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About:
This document provides information on low cost or free health insurance coverage through Husky Health Connecticut. (ENGLISH)
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Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Husky A and Husky B (Spanish)
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About:
This document provides information on low cost or free health insurance coverage through Husky Health Connecticut. (SPANISH)
Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Immunization Requirements 2019-2020
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About:
This document provides immunization requirements for enrolled students in Connecticut schools for 2019-2020 school year.
Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Medical Authorization Form
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About:
Authorization for the administration of medication by school, child care, and youth camp personnel. (FORM)
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Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Medical Exemption Certification
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/uploaded/Avon_School_District/health_services/medical_exemption_certification.pdf
About:
State of Connecticut Department of Public Health Medical Exemption Certification Statement. (FORM)
Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
NASN guidelines for keeping a sick child home
oral health screening (revised july 2018)
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About:
State law required oral health assessment conducted in either grade six or grade seven, and in either grade nine or grade ten.
Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Religious Exemption Statement
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About:
State of Connecticut Department of Public Health Religious Exemption Statement. (FORM)
Print / Download:
Click the image of the document to view online or download. If you need assistance with any of these documents or forms please contact your school nurse.
Please click image to view document.
Please click image to view document.