District Bulletin 

BUL-4480.1, Policy and Procedure for the Acquisition and Use of Automated External Defibrillators (AEDs) - 

AED Daily/Monthly Readiness Status Checklist Form: SY 2022/2023

AED Daily/Monthly Readiness Status Checklist Form 2021/2022:  AED Brand: FRx | CR2

ARU Referral Form (Fillable)

ARU Module in Welligent

ARU Portal Helpful Tips

Authorization to Receive/Release Medical Information

Nursing Office Daily Log

Report of Dental Observation

See Protocol section

Report of Ear, Nose, and Throat Observation

 Notice of First Aid

Food Borne Illness Reporting

Food Handler Certificate

Health Office Referral to Physical Education Teacher

Pupil Health Exclusion, August 2016

School Readmittance

Bulletin 1229.3, 7/2/2018 - Carlson Home, Hospital & Home Online Academy Instructional Services 

Referral Forms:  Home Medical Referral

                           Hospital Medical Referral

                           Psychiatric Referral for Home Instruction

                           Non-Medical Referral for Home Instruction

Policy: BUL-3219.2, Student Medical Exemption and Exclusion Policy and Procedures

Forms:

Request for Medical Exemption

Request for Medical Exclusion

For Transporting Expired Medications and/or Sharps Container

Medical Waste: Checklist, Tracking Document, and Generator Certificate, 2022-2023

***A separate Tracking Document MUST be completed for Medication and Sharps Container. To download another copy of the Tracking Document, click here.

Attachment B Renewal of Request for Medication To Be Taken During School Hours 

Attachment C Training Log

For download: School Year 2022/2023  |   2021 - 2022    |  Attachment D Medication Log. 

Attachment E Request for Self Administration of Medication to be taken During School Hours

Attachment F Student Contract for Self-Administration/Self-Carry of Medication During School Hours

Attachment GAsthma Action Plan. Downloadable version: English | Spanish

Attachment H Medical Waste Transport Preparation Checklist

***When requesting service/support from LASPD Dispatch (213.625.6631) for a student/employee identified as high risk for suicide/threat (per BUL-2637.4, BUL-5799.1, BUL-5798.0), the following Preliminary Information should be provided as indicated in the Mental Health Evaluation Team (MHET) PRELIMINARY INFORMATION Request Form***

MHET Preliminary Information Form

Nurse-Family Partnership Referral Form

Related District Publication:

BUL-3276.1 Compliance on Services for Pregnant Minors and Parenting Minors, August 15, 2007

District Bulletin:

BUL-3585.6, Oral Health Assessment for Kindergarten or First Grade Entry, August 1, 2016

Form:

Oral Health Assessment/Waiver Request Form

Permanent Health History

Principal - Nurse Conference Form

Distance Learning Guidelines for the Credentialed School Nurse

See Protocols section: Seizure Care for more information/forms

 Seizure Record

Special Diet Request Form

Sign in the MyLAUSD first before clicking the links below

Disrict Bulletin:

BUL-4948.2 Medical Clearance and Return to Play Guidelines for Students Participating in Interscholastic 

BUL-6429.3 Athletic Rules and Regulations

Clearance Policy for Student-Athletes with Impaired Vision

Memo:

Athletics Clearance 2021/2022

Guidance for Screening Pre Participation of Examination (PPE) Forms (COVID)

IOC Student Athlete Returning from a Positive COVID-19 Test 

Forms:

PPE with Parent's Section in English

PPE with Parent's Section in Spanish

Medical Conditions and Sports Participation

Athletic Injury Tracking Form

Concussion Injury Report

Flowchart on Concussion Injury Documentation

Medical Clearance Form - to start Stage III of RTP Protocol

Hx of COVID-19 - Sports Participation Parent Letter

Post COVID-19 Return to School and Graduated Return to Play

 Initial Planning Template

Elementary - Information for Sub School Nurses

Secondary - Information for Sub School Nurses

Differential Form

School Nurse (Certificated)

LVN  (Classified)

School Nurse (RN) Employee Initiated Transfer Form, 2/2018

Licensed Vocational Nurse (LVN) (Employee Initiated)Transfer Form

Report of Vision Screening English/Spanish

Report of Color Vision Test

Resources

Guide for Vision Screening

Vision Screening Summary Table

Vision Screening Presentations and Training:

Vision Screening Guidelines_1-25-22

Spot Vision Screener Product Overview Training_1-25-22

District Reference Guide:

REF-5527.0 - Visually Impaired Program: Referral, Assessment, and Scope of Service

Form:

VI Referral Form