Medical Forms

PARENTS - DOES YOUR CHILD HAVE TENN-CARE COVERAGE?

If so, the Nursing Department is allowed to seek reimbursement from TennCare for the healthcare services the School Nurses provide while your child is at school. You will never be charged for healthcare services your child receives in the school district. Please click HERE for more information. Or call Sarah Winters at (615) 893-5815 ext. 22077.

RCS MEDICAL AUTHORIZATION FORMS

Adrenal Crisis Action Plan
Allergy - Non-anaphylactic Allergy Info Sheet
Anaphylaxis Action Plan TDOE Spanish
Anaphylaxis Action Plan TDOE
Asthma Action Plan
Cardiac Action Plan
Concussion Action Plan
Diabetes Orders RCS
Impaired Mobility Health Care Provider Orders
Insect Repellent-Sunscreen-Cough Drops
Liability Waiver for Crutches or Knee Scooter
Liability Waiver for Wheelchair Short-Term Use
Med Auth to Self-Administer Pancreatic Enzymes
Med Auth to Self-Carry Adrenal Crisis Medication
Med Auth to Self-Carry Inhaler Non-asthmatic Use
Medication Authorization and WAIVER Form
Medication Authorization Form
Nurse Health Tips for Common Ailments
Parental Consent Form for Sharing Immunization Data with Registries ARABIC
Parental Consent Form for Sharing Immunization Data with Registries SPANISH
Parental Consent Form for Sharing Immunization Data with Registries
Procedure Authorization
Procedure Auth ENTERAL FEEDINGS (with meds)
Pulmonary Disorder Action Plan
Release of Information
Seizure Action Plan
Sickle Cell Anemia Action Plan
Ventilator Action Plan

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