The Pine School Medical Forms
Click on the appropriate links below to download printable copies of PINE required forms.
- Please refer to M31 for medical information needed for school enrollment. The FL Certificate of Immunization (DH680) and School Health Entry (DH3040) forms are required to be turned in to the school by July 15th. (Those two forms are provided by your pediatrician).
- For medication (prescription or over-the-counter) to be given at school, please have a physician or nurse practitioner fill out Physician Authorization for Medication Form (M34)
- Children who self carry medication need form M35.
- Children with a history of acute allergic reactions need form M36.
- Children who have asthma need form M37.
- Children who have diabetes need form M38.
- M32_K_Immunization Information
- M33_7th Grade Immunization Information
- M34_Physician Authorization for Medication - Authorization for Administering Student Medication (EL-12th grade)
- M35_Authorization for Self-Carry of Medication
- M36_Authorization for Epinephrine - Allergy Emergency Action Plan
- M37_Authorization for Asthma Medication
- M38_Authorization for Diabetes Medication
Parents are required to sign their portion of the forms. Parents/guardians may FAX forms to physician’s office to obtain signature. The physician may FAX the forms directly to the upper or lower school offices.