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Medical form
Please complete the questionnaire below regarding your child's health.
It is important that all children with medical conditions are supported to make sure that they are able to access their education appropriately. Some children with medical conditions may need care or medication to manage their health condition and to keep them well during the school day.
In order to assess your child's needs are appropriately met in school we may need to discuss your child's health with the School Nursing service or other Health professionals who are involved in your child's care.
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* Indicates required question
Name of child
*
Your answer
Class
*
Oak
Cherry
Willow
Beech
Year 3
Year 4
Year 5
Year 6
Name & address of GP
*
Your answer
Does your child have a medical condition/health concern?
*
Yes
No
Does your child have any allergies? eg) nuts, milk, lactose, latex etc.
*
Yes
No
If yes, please state allergy(ies) below or N/A
*
Your answer
If yes please give details below or N/A
*
Your answer
Does your child have a medical condition/heath concern that needs to be managed during the day?
Yes
No
Clear selection
If yes please give details below or N/A
*
Your answer
Does your child take medication during the day?
*
Yes
No
If yes please give details or N/A
*
Your answer
Does your child have a health care plan that should be followed in a medical emergency?
*
Yes
No
If yes please give details or N/A
*
Your answer
Name of person completing form
*
Your answer
Relationship to child
*
Your answer
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