~[wc:commonscripts]
~[wc:admin_header_frame]~[wc:admin_navigation_frame] ~[wc:title_student_begin]Medical Information~[wc:title_student_end]
Home Phone
~(home_phone)
Age
~(age)
~[submitbutton]
Birth Date
~(DOB)
Gender
~(Gender)
Teacher
~(Primary_Teacher)
Father
~(Father)
Daytime Phone
~(FatherdayPhone)
Mother
~(Mother)
Daytime Phone
~(Motherdayphone)
Doctor
Phone Number
ANY MEDICAL
HEALTH ISSUES
ALLERGIES
ASTHMA
TRIGGERS
MEDICAL ALERT
(Will be viewed by teachers)
Alert Expires
(date)
(0/0/0 to never expire)
DIABETIC
Yes
No
Medications at home
Medications at school
Meds at School
Yes
No
Comunicable Diseases
Other
Consent To Treat
IMMUNIZATION
~[x:insertfile;med_immunization.html]
HIB
(Dates)
HEPATITIS B
(Dates)
VARICELLA
(Dates)
MMR
(Dates)
MEASLES
(Dates)
RUBELLA
(Dates)
MUMPS
(Dates)
OTHER IMMUNIZATIONS
HEIGHT
WEIGHT
BMI>85%
Yes
No
LEAD ASSESMENT
LEAD SCREEN
LEAD RESULT
TB SKIN TEST
DATE
Test Results
Pos
Neg
TB X-RAY
DATE
X-Ray Results
Pos
Neg
Physical Exams (Dates)
Dental Exams (Dates)
SCREENING
~[x:insertfile;med_screenings.html]
~[submitbutton]
~[wc:admin_footer_frame]