Health Services 

Forms for Students

Immunization Report If you did not complete the immunization report for your student through the online registration system, please complete this form and submit it to your school, or submit an immunization report provided by your physician's office. For the immunization requirements for students for the 2018-2019 school year, please see 2018-2019 Immunization Information for Enrollment.

Physician's Report —  It is recommended that you complete and submit this form only for the first year that your child is enrolled in Upper Arlington Schools

Additional Forms

Please complete at the direction of your school nurse.

Prescribed Medication Authorization

Authorization for Non-Prescription Medication or Treatment

Asthma History

Asthma Action Plan

Authorization for Student Possession and Use of Asthma Inhaler — for students who will carry and self-administer an asthma inhaler

Life-Threatening Allergy Action Plan

Life-Threatening Allergy History

Authorization for Student Possession of and Use of an Epinephrine Autoinjector - for students who will carry and self-administer an epinephrine autoinjector

Diabetes Medical Management Plan

Seizure Care Plan


If you have any questions about these forms, please contact your school nurse.

Nikki Kennedy, RNBarrington(614) 487-5180 Ext. 5003
Janice Walsh, RN Wickliffe(614) 487-5150 Ext. 6503
 Windermere(614) 487-5060 Ext. 7003
Jayna D'Herete, RN Greensview(614) 487-5050 Ext. 5503
Ruth Sacolick, RNTremont(614) 487-5170 Ext. 6003 
Gini Barber, RN Hastings(614) 487-5100 Ext. 4003
Jane Mead, RN Jones (614) 487-5091 
Laurie Long, RNUAHS(614) 487-5278

Upper Arlington Schools

1950 North Mallway Drive
Upper Arlington, Ohio 43221
Phone icon (614) 487-5000
  (614) 487-5012


1950 North Mallway Drive
Upper Arlington, Ohio 43221
(614) 487-5000

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