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Emergency Medical Referral Card

All students should have the below emergency medical referral card on file at their school's health office. Please download and print the document before filling out and returning to the health office at your school. 

A medical history and consent form is presented with fields for student information, emergency contacts, health history, and medication consent, all set against a white background.

Click to view/download English or Spanish versions of PDF. 

5-404_MedicalHistoryConsentForm-Spa5526 (PDF)

Click to view/download English or Spanish versions of PDF.