Health Services

Forms can be returned or faxed to your child's school.

For questions, contact:
Pam Jesse, RN
District Nurse
(262) 789-6439
(262) 789-6261 (Fax)

Click on a form below to download. Requires Adobe Acrobat Reader to open.

Medical Forms

Asthma Health Care Form
Allergy Health Care Form
Authorization for the Administration of Non Prescription Medicine
Authorization for the Administration of Prescription Medicine
Student Emergency Information Form
School Dental Referral Form
Student Health Examination Form
Requested for students entering grades K, 5, 9

Immunization Information

Waukesha County Immunization Clinics
As of October 1, 2012- Health Dept changes
Beginning October 1, 2012, individuals whose insurance covers immunizations will not be able to be immunized with state supplied vaccine (i.e., federally purchased 317 vaccine), even if the insurance includes a high deductible or co-pay, or the plan?s deductible has not been met. Please see attached letter.
Wisconsin Immunization Registry
Meningitis Fact Sheet
Meningitis Letter for Parents
2012-2013 School Year Immunization Facts
Student Immunization Record
Last Updated 1/15/13

H1N1 Flu Information

A Guide for Parents - Seasonal & H1N1 Flu
Posted 10/20/09
Stop Germs at Home

Health Information

When to Keep Your Child at Home
Treat Guidelines / Peanut Allergies
Medication Policy

Lice Information

S.C.R.A.T.C.H Slideshow
Fact sheet

School Fax Numbers

 

Elmwood Elementary
(414) 427-7290
Orchard Lane Elementary
(262) 789-6286
Poplar Creek Elementary
(262) 789-6234
Ronald Reagan Elementary
(262) 789-6205
Eisenhower Middle & High
(262) 789-6313
New Berlin West Middle & High
(262) 789-6442

 

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