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Student Health Care Forms and Information

Asthma Medication Plan 7/2023

Asthma Medication Plan.pdf 250.55 KB (Last Modified on January 26, 2024)

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CCS Medication Administration Protocol 1/2024

Protocol for Medication Administration Jan 2024.docx.pdf 2.6 MB (Last Modified on January 26, 2024)

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Protocolo de administracion de medicamentos

Protocol for Medication Administration Jan 2024 - Spanish.pdf 1.84 MB (Last Modified on May 9, 2024)

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Cystic Fibrosis Self-Medication Authorization Form 4/2022

Cystic Fibrosis Self-Medication Authorization Form 4_2022.pdf 243.44 KB (Last Modified on January 26, 2024)

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Diabetes Health Care Plan 6/2024

Diabetes Health Care Plan Rev. 06-2024.pdf 414.96 KB (Last Modified on June 26, 2024)

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Emergency Self-Medication Authorization Form 8/2012

Emergency-Self-Medication-Authorization-Form.pdf 18.09 KB (Last Modified on July 6, 2020)

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Unique Mealtime Needs Request Form-Temporary 8/2018

Unique-Mealtime-Needs-Request-Form-Temporary-Rev.-08-2018.pdf 110.66 KB (Last Modified on July 6, 2020)

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Medical Statement for Students with Unique Mealtime Needs for School Meals 6/2017

2018-Medical-Statement-Form.pdf 440.65 KB (Last Modified on July 6, 2020)

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Physician's Health Care Orders for School 6/2022

Physicians Health Care Orders for School Rev. 6-2022.pdf 86.32 KB (Last Modified on January 26, 2024)

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Las Escuelas Del Condado De Cumberland Ordenes De Cuidado Del La Salud Del Medico Para La Escuela

Physicians Health Care Orders for School Rev - Spanish.pdf 120.46 KB (Last Modified on May 9, 2024)

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Physician's School Medication Form 5/2018

Physicians School Medication Form Rev. 05-2018.pdf 368.19 KB (Last Modified on July 6, 2020)

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Las Escuelas Del Condado De Cumberland Formulario Medico De Medicacion Escolar 5/2018

Physicians School Medication Form Rev - Spanish.pdf 146.42 KB (Last Modified on May 6, 2024)

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Seizure Care Plan 8/2018

Seizures-Care-Plan-Rev.-08-2018.pdf 451.94 KB (Last Modified on July 6, 2020)

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Severe Allergy Medication Plan 6/2018

Severe-Allergy-Medication-Plan-Rev.-06-2018.pdf 267.58 KB (Last Modified on July 6, 2020)

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Escuelas Del Condado De Cumberland Plan De Medicacion Para Alergias Graves 6/2018

28 Severe Allergy Medication Plan Rev - Spanish.pdf 505.91 KB (Last Modified on May 3, 2024)

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Short-term Medication Form 5/2018

Short-term-Medication-Form-Rev.-05-2018.pdf 271.48 KB (Last Modified on July 6, 2020)

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Las Escuelas Del Condado De Cumberland Formulario De Medicacion A Corto Plazo 5/2018

14 Short-term Medication Form Rev - Spanish.pdf 100.83 KB (Last Modified on May 3, 2024)

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Shunt Action Plan 5/2015

Shunt-Action-Plan-Rev.-5-2015.pdf 131.34 KB (Last Modified on July 6, 2020)

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Sickle Cell Action Plan 5/2013

Sickle-Cell-Action-Plan.pdf 56.59 KB (Last Modified on July 6, 2020)

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Two Way Consent for Exchange of Information 8/2017

Two Way Consent for Exchange of Information Rev. 08-2017 -New Logo Added.pdf 189.92 KB (Last Modified on July 6, 2020)

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Homebound Services Forms

Homebound Description of Services 7/2014

Homebound_Description_of_Services_Rev._7-2014.pdf 304.32 KB (Last Modified on October 17, 2023)

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Homebound Parent Permission & Release Form 4/2022

Homebound Parent Permission Release Form Rev. 4-2022.pdf 197.95 KB (Last Modified on January 26, 2024)

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Homebound Parent Permission & Release Form in Spanish

Homebound_Parent_Permission_Release_SPANISH_Rev._7-2014.pdf 202.96 KB (Last Modified on October 17, 2023)

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Homebound Physician's Referral Form 6/2022

Homebound Physicians Referral Form Rev. 6-2022.pdf 311.26 KB (Last Modified on January 31, 2024)

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Homebound Principal Approval Form

Homebound Principal Approval Form.pdf 124.66 KB (Last Modified on January 31, 2024)

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Homebound Student Diagnosed with Emotional Form 11/2023

Emotional Disturbance Form Nov 2023.pdf 32.09 KB (Last Modified on January 31, 2024)

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Contact Us

Health Services
Cumberland County Schools
800 North Street
Fayetteville, NC 28301
910-678-2406
FAX: 910-483-7835

Shirley Bolden, MSA
Director of Health Services

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