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School Clinic Medical Forms

Administration of Medication Form

AUTHORIZATION TO GIVE MEDICATION AT SCHOOL.pdf 78.42 KB (Last Modified on December 19, 2023)

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Affidavit of Religious Exemption to Immunization

Religious Affidavit.pdf 67.07 KB (Last Modified on December 19, 2023)

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Bumped Head letter

Parent letter for head bump--concussion.pdf 147.25 KB (Last Modified on August 2, 2024)

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Individual Health Care Plan

Individual Health Care Plan 23-24.pdf 103.58 KB (Last Modified on June 6, 2024)

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Invasive Procedures Form

Invasive Procedures forms.pdf 759.69 KB (Last Modified on July 30, 2024)

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Medication Administration Skills Checklist

Medication Administration Skills Checklist final 7.26.pdf 152.22 KB (Last Modified on July 30, 2024)

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Medication Count Form

Medication count form.pdf 99.9 KB (Last Modified on August 2, 2024)

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Richmond County Asthma/Allergy Plan

Student_Asthma_Allergy_Action_Plan_Form.pdf 157.55 KB (Last Modified on June 6, 2024)

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Sample Certificate of Eye, Ear, Vision and Nutrition Exam -- GA

This form must be obtained and completed at a local health department or physician office.

Form 3300 Revised.pdf 354.55 KB (Last Modified on June 25, 2018)

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Sample Immunization Form 3231 - GA

These forms must be obtained and completed at local public health departments or physician offices.

blank_3231_sample_2020.pdf 112.59 KB (Last Modified on June 28, 2021)

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School Clinic Nurse Forms

Notifiable Disease Condition Reporting

Notifiable_Diseases_Poster_relFINAl_1.07.25.pdf 1.14 MB (Last Modified on March 18, 2025)

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Hearing and Vision Screening Form

Vision and hearing results form.pdf 120.72 KB (Last Modified on March 18, 2025)

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Clinic Wrap Up Form

CLINIC WRAP UP FORM updated 4-24-2024.pdf 41.72 KB (Last Modified on March 18, 2025)

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Nurse Supply Request Form

RCSS Nursing Supply Request Form.pdf 111.99 KB (Last Modified on December 3, 2024)

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School Nurse Referral Form

School Nurse Referral form.docx 116.26 KB (Last Modified on December 3, 2024)

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sub notebook communication page

Communication Information.docx 19.42 KB (Last Modified on December 3, 2024)

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sub notebook daily medications and procedures

Daily Medications and Procedures.docx 20.43 KB (Last Modified on December 3, 2024)

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sub notebook employee list

employee list.docx 24.49 KB (Last Modified on December 3, 2024)

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sub notebook front page

front page.docx 22.66 KB (Last Modified on December 3, 2024)

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Sub notebook Medical alert page

med alert.xlsx 23.63 KB (Last Modified on December 3, 2024)

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Staff and Parent Education Links

Staff and Parent Education Documents

Teen Vaccination Fact Sheet

Teen Teaching Sheet 1.31.17.pdf 185.51 KB (Last Modified on February 13, 2025)

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Diabetic Fact Sheet

Diabetes_Factsheet_relFINAL7.31_2.pdf 94 MB (Last Modified on February 13, 2025)

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Diabetes Education PowerPoint

Diabetes Training for School Personnel.pdf 363.2 KB (Last Modified on August 1, 2024)

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Asthma/Allergy Education Power Point

Asthma Training for School Personnel -.pdf 793.33 KB (Last Modified on August 1, 2024)

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Seizure Education Power point

Seizure Training for School Staff 24.25.pdf 713.41 KB (Last Modified on August 1, 2024)

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Diabetic Medical Management Plan

Blank-DMMP.gadoe.pdf 106.75 KB (Last Modified on July 30, 2024)

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RCSS Asthma Action Plan /Epipen

Student_Asthma_Allergy_Action_Plan_Form.pdf 157.55 KB (Last Modified on July 30, 2024)

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Seizure Action Plan

CNF_Seizure_Action_Plan_v4_fillable.pdf 280.71 KB (Last Modified on July 30, 2024)

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2024 Georgia School Health Resources Manual

Preface and Table of Contents

School-Health-Manual_Preface-and-Table-of-Contents.pdf 1.04 MB (Last Modified on July 30, 2024)

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Chapter 1 School Health Services and School Nursing Practice

School-Health-Manual_Ch.1-School-Health-Services-and-School-Nursing-Practice.pdf 2.92 MB (Last Modified on July 30, 2024)

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Chapter 2-- Injury Management and Emergency Medical Concerns

School-Health-Manual_Ch.2-Injury-Management-and-Emergency-Medical-Concerns.pdf 3.19 MB (Last Modified on July 30, 2024)

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Chapter 3 Administration of Medications

School-Health-Manual_Ch.3-Administration-of-Medications.pdf 2.45 MB (Last Modified on July 30, 2024)

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Chapter 4 --Communicable Diseases and Infection Control

School-Health-Manual_Ch.4-Communicable-Diseases-and-Infection-Control.pdf 1.47 MB (Last Modified on July 30, 2024)

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Chapter 5 Chronic Health Conditions

School-Health-Manual_Ch.5-Chronic-Health-Conditions.pdf 6.72 MB (Last Modified on July 30, 2024)

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Chapter 6 -- Special Health Procedures in a school setting

School-Health-Manual_Ch.6-Special-Health-Procedures-in-a-School-Setting.pdf 1.58 MB (Last Modified on July 30, 2024)

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Chapter 7 Behavior and Mental Health in Schools

School-Health-Manual_Ch.7-Behavioral-and-Mental-Health-in-Schools.pdf 1.26 MB (Last Modified on July 30, 2024)

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Chapter 8 Screening Considerations in the School Setting

School-Health-Manual_Ch.8-Screenng-Considerations-in-the-School-Setting.pdf 2 MB (Last Modified on July 30, 2024)

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Chapter 9 Schoolwide Health Promotion

School-Health-Manual_Ch.9-Schoolwide-Health-Promotion.pdf 789.76 KB (Last Modified on July 30, 2024)

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Parent and Student Wellness

Flu Education Resource

CHOA Flu Resources Flyer.pdf 170.39 KB (Last Modified on December 3, 2024)

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Cold versus Flu

Cold Versus Flu.pdf 532.59 KB (Last Modified on January 14, 2019)

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When to Your Child Needs to Stay Home

When_Your_Child_Needs_to_Stay_Home.pdf 246.76 KB (Last Modified on January 14, 2019)

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Handwashing Basics

National Handwashing Awareness Week 2018.pdf 160.97 KB (Last Modified on January 14, 2019)

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School Nurse Supervisor

Tina Wisniewski - Nurse Supervisor

Direct: 706-826-1310, Ext 5491

Department: 706-826-1129

Fax: 706-826-4626

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