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Health Services Forms

We're going electronic!

For the 2015-2016 school year, we will be using Magnus Health to collect student medical forms and information online. On or around June 1, 2015, parents will be able to log on to the Magnus Health site to input your child's medical information and download applicable forms. Information on how to access these forms online will be sent to parents sometime in May. 

If your child has a medical appointment and you need any of the forms below before they are available at Magnus Health before June 1, please download the applicable forms below and return them to:    
           Hathaway Brown School
           ATTN: Jody Duecker
           19600 N. Park Boulevard
           Shaker Heights, OH  44122 

You will be able to complete any other forms including the Emergency Form and also be able to input your child's medical information at Magnus Health beginning June 1.

Emergency Forms (only available at Magnus Health beginning June 1, 2015)
Early Childhood Emergency Care, OTC, Medical Permission Form
Grade K-12 Emergency Care, OTC, Medical Permission Form

Physical Examinations
Physical Examination Form (General Student Form)
Immunization Requirement for Students Entering 7th Grade
Medical, Religious, or Philosophical Exemption Form

Medication at School
Letter to Parents: Medication Policy
Physician and Parent Request for the Administration of Medication by School Personnel

Diabetic Health Care Plan
Physician Authorization/Parent Request for Blood Sugar Testing in the Classroom

Asthma Action Plan
Self-Medication for Asthma Inhalers, Authorization Form

Allergy Action Plan
Authorization for Student Possession and Use of an Epinephrine Autoinjector

Seizure Action Plan

Athletic Forms
OHSAA Physical Form 2015-2016 (Student Athlete Form)
Concussion & Head Injury Information Sheet & Acknowledgement Form for Student Athletes Grades 7-12
Youth Sports Concussion Information Sheet  

Screenings - Please contact the school nurse at 216-320-8092 if you need a replacement copy of the following nurse-issued forms:
      Vision Screening Referral Report
      Ohio Department of Health, Eye Specialist Report
      Hearing Screening Referral Report
      Postural Screening Referral and Medical Report

The full time Registered Nurse, Judy Wilson, can be reached Monday through Friday during regular school hours at 216-320-8092. 

Shaker Heights, Ohio Girls K-12 Coed Early Childhood

19600 North Park Boulevard Shaker Heights, Ohio 44122 P: 216.932.4214
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