Ê®·ÖÁùºÏ²Ê

The role of the school nurse is to enhance the education process by maximizing the health and well-being of school age children and adolescents. 

The school nurse works with the building staff and parents to ensure that each child is in the best possible physical and emotional health to benefit from school experiences. 

The school nurse implements programs and services designed to provide for the detection and follow-up of health problems, crisis intervention for ill and injured students, health counseling and referral, control of infectious disease within the school environment and planning with other school personnel for the appropriate education placement of the students with health problems. 

Salwa Hussein
Nurse   

hussein_salwa@asdk12.org
742-4700

About Health Services

The Health Services Program strengthens the educational process through health supervision and and health education of children and youth. School nurses promote health by providing knowledge to influence individual and group health attitudes. The goal is to encourage students to incorporate health learning experiences and form their own plan for healthful living. The challenge of the school nurse is to use the combined strength of scientific knowledge, professional skill, individual commitment and community support to enable students to achieve their potential to live full, active lives. 

It is also the aim of the Health Services Program to carry out school health regulations required by the  and the . The purpose of the Health Services Program is to appraise, protect, promote and maintain the health of students.

These forms are posted as PDF documents and they require the free Acrobat Reader to be viewed. Most forms are formatted so you can fill them out online, print them and then be mailed or dropped off at the school or department. Please be aware that due to the limitations of the free Adobe Acrobat Reader software you will be unable to save your changes unless you have a full version of Adobe Acrobat. 

Health History Form 301
For all students - preschool, kindergarten, returning, new to Ê®·ÖÁùºÏ²Ê, and transfers

PPD Tuberculin Skin Test Consent or Exemption Form 363
For kindergarten, new to Ê®·ÖÁùºÏ²Ê (never enrolled before), and 7th grade

Required Immunization Statement for Provisional School Enrollment

Information Release Forms

Authorization for Release of Immunization/TB Records
AK Department of Health and Social Services' authorization to release immunization and/or TB records

Consent for Release of Information
Ê®·ÖÁùºÏ²Ê's form authorizing release of health and educational information

Authorization for Self-Carry/Administration of Medicine at School and After-School Activities Form 902
Parent permission form allowing for a responsible, trained student to carry and/or self administer prescription labeled medication for asthma, severe allergic (anaphylactic) reaction, or diabetes.

Long Term Non-Prescription Medication Request
Parent permission form for requesting the district give non-prescription medicine under certain conditions.

Long Term Request for Administration of Prescribed Medication Form 317B
This form or a written statement signed and dated by the physician is required for medication prescribed for more than 15 days.

Short Term Prescription Medication Request Form 317C
Parent permission form for allowing school personnel to administer health care provider prescribed short-term prescription medicines for a period of time not to exceed fifteen days. 

Exemption Forms

Religious Exemption
Use this form to request an exemption from immunizations based on the tenets or practices of a church or religious denomination.

Medical Exemption 
Use this form to request an exemption from immunizations in situations where immunizations would be injurious to the health of the student or other household members.