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Health Forms
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Coordinated Student Health Services Department provides health and wellness for students to develop healthy lifestyles. The following resources are provided as noted below:
Student Health Info/Parent Letter
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Overview of School Health Services
The following information is to assist you, as the parent/guardian, with providing health information required for your child by Broward County Public Schools. If you should have any questions, please feel free to contact your school.
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Health Condition Review Form
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Consent for School Health Services
The consent for School Health Services can be found on the back of the Emergency Contact Form. The form should be completed, signed, and dated by the parent/guardian to ensure students can receive health services at school or in school-sponsored activities.
Emergency Contact Form (English)
Emergency Contact Form (Spanish)
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School Health Entry Exam (Yellow Form)
All students entering Broward County Public Schools for the first time must have a medical examination performed within one year of registration. The medical examination should be documented on the Florida Department of Health Form 3040 or the provider’s office/medical facility stationery. The appropriate form/stationary should be completed, signed, and dated by the healthcare provider.
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Florida Certification of Immunization (Blue Form)
Make sure your child’s required immunizations are up to date. If you are not sure, you can check with your healthcare provider or the Florida Department of Health-Broward at (954) 467-4700.
Parents may obtain medical exemptions from their healthcare provider or a religious exemption from the Florida Department of Health Broward.
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Authorization for Medication/Treatment Form
For more information, see the Medication/Treatment Administration During School section.
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Authorization for Selected Over-the-Counter Medication (OTC) with Parental Approval (Grades 9-12 Only)
For more information, see the Medication/Treatment Administration During School section.
Authorization for Over-the-Counter with Parental Approval Form (Grades 9-12 only)
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Diabetes Medication Treatment Authorization
For more information, see the Chronic Health Conditions section
Contact Information
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Coordinated Student Health Services
1400 NW 14 Court
Fort Lauderdale, Florida 33311
Phone: --
Heather Katcher RN, MSN, CPN, NCSN
Director