Health Services Assistant
(805) 520-6830, Extension 7022
Mary Carol Sorrells, RN
(805) 520-6830, Extension 7023
Health Office Forms
The following forms are available in pdf format. Please print, fill out and bring the form to the Health Office or Fax it to 805-520-6835. The top of the form must be completed and signed by the parent/guardian, the bottom of the form must be completed and signed by the physician.
FORMS IN ENGLISH:
- Allergy/Anaphylaxis Emergency Plan (pdf)
- Allergy Health Record Update (pdf)
- Asthma Health Record Update (pdf)
- Authorization for any Medication Taken During School Hours (pdf)
- Diabetes - Physician Authorization Health Care Services at School (pdf)
- Readmission after Accident/Injury (pdf)
- Seizure Information/Contact Sheet (pdf)
FORMAS EN ESPAÑOL:
- Actualización del registro de salud para alergias (pdf)
- Asma – Información Al Día De Salud (pdf)
- Autorización Para Tomar Medicina Durante El Horario Escolar (pdf)
- Diabetes – Autorización Del Médico Para El Cuidado De Salud En La Escuela) (pdf)
- Hoja De Información Y Contacto En Caso De Convulsiones (pdf)
- Plan De Emergencia Para Alergias / Anafilaxia (pdf)
- Readmisión a la escuela del estudiante con la incapacidad temporal por lesiones, enfermedad o cirugía (pdf)
According to California law, we cannot allow your child to attend school until we receive evidence that all immunization requirements have been met.
Health Office (805) 520-6830, Extension 7022
Please visit the Health Office for:
- First aid or any health problems
- Permission to go home due to illness
- Permission to be excused from PE when required by a doctor’s note. All notes go through the Health Office and a form will be given to the student to turn into their PE teacher. A parent note with dates, may excuse a student for up to 3 days only!
- Students MUST GET A PASS from a teacher before going to the health office. It is against school policy for students to text/phone a parent during class time or passing periods. We need to know if students are not feeling well!
Medication, including over-the-counter medicines, cannot be administered by the school or brought to school without a written doctor’s note and the following AUTHORIZATION TO TAKE MEDICATION DURING SCHOOL HOURS form. Printed forms are also available in the Health Office. Medication must be brought in its original container.
Students returning to school wearing a brace, cast, sling or splint; using crutches or a wheelchair; or any other medical device MUST have a doctor’s note to be allowed to attend or stay in school, along with the READMISSION TO SCHOOL OF STUDENT WITH TEMPORARY DISABILITY form to be completed by the student's parent and doctor. Printed forms are also available in the Health Office. Please know that students must wear shoes at all times while on campus, and the shows must have enclosed heels or a heel strap.
Local Health Services Information
If you have questions about the Tdap immunization requirement, please contact our school nurse, Mary Carol Sorrells, RN, at (805) 520-6830, Extension 7023 or email@example.com.
Free Clinic of Simi Valley
2003 Royal Avenue
Simi Valley, CA 93065
BY APPOINTMENT ONLY
Sierra Vista Family Medical Clinic
1227 E. Los Angeles Avenue
Simi Valley, CA 93065
BY APPOINTMENT ONLY
To enroll in Medi-Cal, contact:
Ventura County Human Services Agency
Ventura County Public Health
2240 E. Gonzalez Road,
Oxnard, CA 93065
Many local pharmacies offer Tdap during regular business hours including: Albertsons/Savon, Rite Aid, Walgreens, Vons, Costco, & CVS.
To Learn More About California's Required Immunizations, please click below.
Shots For School 7th Grade
The school immunization law requires all students entering 7th grade in the 2020-2021 school year in California to be immunized with a pertussis (whooping cough) vaccine booster called Tdap. Students will also be required to show proof of Varicella (Chicken Pox) doses 1 and 2. Both doses are required!
Pertussis is a very contagious respiratory disease that can be severe and last for months. The immunity received from either early childhood immunization or pertussis disease wears off over time, leaving older students and adults susceptible again to pertussis. Immunization with Tdap can protect students, schools and communities against pertussis.
The new requirement affects ALL students (current, new, and transfers) in public and private schools.
To facilitate the documentation of this vaccination and to ensure that your student will be able to enter school in August, our schools request that proof of this immunization be submitted to their school offices no later than May 2020.
No 7th graders will be allowed to start school until proof of immunizations have been turned in.
Health Care Information