Blevins Middle School

It's All Good in the Neighborhood

Health Forms

Health Information:

IMMUNIZATIONS: You must provide one of the following to your child’s school in order to comply with Colorado immunization requirements: 1. A completed Certificate of Immunization certifying your student has received minimum immunizations (as indicated below)  OR  2. Statement of Exemption to Immunization Law.

Required Immunizations: 5 DTaP / Td / DTP: Diphtheria, tetanus, pertussis (4 is acceptable if 4th given after the 4th birthday) 1 Tdap: Tetanus, diphtheria, pertussis (required for all 6th through 12th graders) 4 IPV / OPV: Polio (3 is acceptable if 3rd is given after the 4th birthday) 3 shot series for Hepatitis B: 2 shot series acceptable if given between 11-15 years 2 MMR: Measles, mumps, rubella Varicella: 2 vaccines are required grades K through 12 –or– documentation on medical record of history of disease or lab confirmation.

To avoid exclusion from school, please submit proof of these immunizations as soon as possible to the Blevins Health Office. Fax immunizations or request your doctor’s office fax immunization records to Blevins at (970) 488-4011, Attn: Taylor Morgan. We appreciate your prompt attention and help.

HEALTH CARE ACTION PLANS: Your child is unique. Please give us details about any health concerns that your child may have so we may be of assistance to your child at school. The school nurse will review any information you provide and a Health Care Plan may be developed. Health Care Action Plan forms are available in the Blevins Health Office or the PSD Website. This form must be signed by a parent/guardian and a physician. Parents/guardians may fax Health Care Action Plans to the physician to sign. Return the signed forms to the Blevins Health Office. Examples of Health Care Plans: Migraines or frequent headaches, Asthma, especially inhaler users, Severe Allergies, especially Epi-pen users, Diabetes, Seizures.  Health Care Action Plans must be renewed yearly.

MEDICATION AT SCHOOL:  ALL medications (doctor prescribed or over-the-counter) given at school must be accompanied by a PSD Authorization and Release form. This form must be signed by a parent/guardian and a physician. The medication must be provided to Blevins in the original prescription or over-the-counter container, accompanied with the completed PSD Authorization and Release form. Medication must be brought to school by parent/guardian. Students may carry their inhaler or Epipen/antihistamine for a severe allergic reaction; however a medication permission form must be completed and kept on file in the Health Office for the current school year. Health forms are available at the Health Office or on the PSD Website under the Parent tab, Health Services. The School Nurse and Health Technician want to meet the needs of your child to insure a safe and healthy school year. For any questions, please call the Health Office at 488-4007. Thank you for your assistance. Heather Haycraft, RN BSN – Nurse Taylor Morgan – Health Tech

Visit the PSD website to obtain all required medication forms, Health Care Action plans, immunization forms and find information on Student Health: Click Here.

PSD recommendation for when to keep your child at home