FORMS

Form

 

All of these forms are required by the State to be on file. These forms must be turned in before or no later than the first day your child attends school.

Click on the tabs below to view and download the forms that you need.

Once you have the forms, please completely fill them out, sign, and return them to us either by mail (P.O. Box 1630), by bringing them in, or by scanning them and emailing them to info@edse.org or faxing them to 1-303-379-1509. The "1" must be used for the fax to go through even if it is a local fax. Your health care provider can fax the Immunization Record to us at the same fax number. Please remember the General Appraisal Form has a section for both the parents and the health care provider to fill out and sign. If you have already filled out the parent section of the General Appraisal Form when you bring it to your health care provider, he/she can fax it to us along with the Immunization Record.

 

Tips for Filling out the Required Forms:

1. All forms must be completely filled out, signed and dated.

2. Information regarding Hospital of Choice, local Health Care Provider, and Insurance which is located on the Emergency Healthcare Authorization Form must be completed. If you do not have a hospital of choice, you may choose to use the “nearest” hospital. If you have recently moved to the area and do not currently have a local Health Care Provider, you may leave that blank, however you must inform us in writing of your new Health Care Provider within two weeks of your start date.

3. Complete and sign the “Parent” section of the General Appraisal Form before you have your Health Care Provider fill out their section of the form. Your Health Care Provider’s signature, date, next well visit due date, and office stamp must be provided for the form to be valid.

4. Children needing medications during the school day and children with medical conditions such as severe food allergies and seizures must have special forms filled out by you and your Health Care Provider and returned to us one week before you child’s first day. This gives our Nurse Consultant time to go over the required forms and discuss with you your child’s specific needs while attending EDSE.

5. If your Health Care Provider faxes us your child Immunization Record, you do not need to have him/her fill out the Immunization Certificate provided in packet of required forms.

6. Completed forms may be handed into the EDSE Office, scanned and emailed to info@edse,org or faxed to 1-303-379-1509. The “1” must be used for the fax to go through, even for local faxes.

7. If you choose for your child to be Exempt from Immunizations, we must receive a State approved Exemption Form. Current Exemption Forms are found at: https://www.colorado.gov/cdphe/vaccine-exemptions Be sure to click on the Downloadable Non-Medical From for personal exemptions (religious or personal). Your Health Care Provider must fill out a medical exemption form (also found on the same web page).

Medication Administration Exchange of Health Information Seizure Questionnaire Seizure Action Plan Allergy Anaphylaxis Emergency Plan

 

Please contact Jerri Avery, RN, the EDSE Nurse Consultant, if your child requires medication or has a medical condition and she will inform you which forms you must provide. She can be reached at jerri@edse.org or by calling 303-674-9253.