Extended school closure
Upper Arlington Schools offices remain closed at this time. If you need further assistance, please call (614) 487-5000.

Health Office and Forms

COVID-19 Update

Upper Arlington Schools is working closely with state and local health officials as we continue to monitor the COVID-19 situation. We are committed to implementing public health recommendations as required. Updated information will be shared with students, staff and families as it becomes available via email and on our homepage under District News.


We encourage you to consult these resources for additional information about COVID-19.

Required Forms for Students

Immunization Information

Immunization Report — If you did not complete the immunization report for your student through the online registration system, please complete this form and submit it to your school, or submit an immunization report provided by your physician's office. 
 
Per Ohio law, new students (kindergartners and students new to the district) are required to have documentation of the state required immunizations on file at their school. Please be sure to submit the your child's immunization record to your school nurse as soon as possible. The state of Ohio allows a 14-day period after entrance to school to submit the immunizations. 
 
For the immunization requirements for students by grade level, please see: 
 
For the 2019-2020 school year: 
 
For the 2020-2021 school year: 
 
For questions about immunizations, or if your child needs additional immunizations, first contact your child's primary care provider. If you need to connect with a vaccine clinic, please visit these webpages for additional details and contact information:
 
 

Physician's Report (For New Students only)

Physician's Report —  It is recommended that you complete and submit this form only for the first year that your child is enrolled in Upper Arlington Schools 

Additional Forms

New paperwork is required for each school year.  Please turn in paperwork and emergency medication to your school office or health office by the first day of school. Thank you for your help and cooperation in getting each school year off to a great start!
 
Please access the collection of forms for various health needs by clicking their name below.

Prescribed Medication Form

 
This form is to be completed for any prescribed medication that is to be given during school hours.  Parents/guardians read and complete the top portion. Your health-care provider completes the bottom portion. Click the above link above to access a printable copy of this form.  
 

Life Threatening Food Allergy Forms

 
Please complete both sides of the Life-Threatening Allergy Action Plan.  This plan needs to be completed for each school year and does require a physician signature.  Please check to see that your child's medication has not expired before turning it in to the health office. Expired medications cannot be sent on field trips or administered in the school setting. You may click on the link above for a printable copy of this form.
 
 
 
This form should accompany the action plan for any prescribed medication that is part of the plan. For example, epinephrine or a prescribed dose of an antihistamine. Parents/guardians read and complete the top portion.  Your health-care provider completes the bottom portion. Click the above link above to access a printable copy of this form. 
 
 
 
Complete this form once upon entrance to the school district or anytime there are significant changes. Click the above link for a printable copy of this form. 
 
 
Authorization for Student Possession of and Use of an Epinephrine Autoinjector (PDF)
Please complete this form if your student will carry and self-administer an epinephrine autoinjector. Recommended for middle school and high school students only.
 

Asthma Forms

 
Parents/guardians, please fill out the Asthma History Form and complete the Asthma Care Forms and prescription authorization in conjunction with your child's primary care provider. These forms tell us about your student's asthma history, triggers, recent hospitalizations, and medications, and a new set will need completed for each school year. Please click the link underlined above for a printable copy of the Asthma Care Forms. 
 
 
Authorization for Student Possession and Use of Asthma Inhaler (PDF)
Parents/guardians, please complete this form if your student will carry and self-administer an asthma inhaler. Recommended for middle school and high school students only.
 

Seizure Plan Forms

 
Parents/guardians, please complete part 1 - Questionnaire for Parent of a Student with Seizures.  A physician signature is required as well as a parent/guardian signature on the third page - the Seizure Action Plan.
 
Text-only version: Seizure Care Plan Forms (.rtf) 
 
 
This form is to be completed for any prescribed medication that is to be given during school hours.  Parents/guardians read and complete the top portion. Your health-care provider completes the bottom portion. Click the above link above to access a printable copy of this form.  
 
 

Diabetes Care Plan

 
This is a sample of a diabetes care plan.  Your healthcare provider may have their own diabetes care plan completed for your child. Click the underlined link above to download a copy if desired.

If your student has been prescribed emergency glucagon, please know that our school nurses train the teachers each year how to administer this life-saving medication.  Your child's glucagon will be kept in the health clinic and will follow them on all field trips.
 
Text-only version: Diabetes Care Plan (.rtf) 
 
 
If your student has been prescribed emergency glucagon, please have your physician complete the prescribed medication authorization form for glucagon.  This form does require both physician and parent/guardian signatures.
 
  

School Health Offices

High School 
Lead nurse 
(614) 487-5278
 
Hastings 
(614) 487-5100, ext 4003
 
Jones 
(614) 487-5091 
 
Barrington 
(614) 487-5180, ext 5003
 
Greensview  
(614) 487-5050, ext 5503
 
Tremont  
(614) 487-5170, ext 6003
 
Wickliffe and Windermere 
Wickliffe Phone: (614) 487-5150, ext 6503 
Windermere Phone: (614) 487-5060, ext 7003
 
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