Forms

Medication Forms

If it is necessary for your child to receive medication during school hours, specific school district forms must be completed. For prescription medication, a parent/guardian signature and the signature of a doctor is required. For over-the-counter medications, a parent signature is all that is required. All prescription medications must be brought to school in the original pharmacy-labeled container. All over-the-counter medications must be in the original packaging.

If prescription medication will be provided or administered at school, a Care Plan OR a Medication Consent Form signed by the PARENT and DOCTOR is required. 

For non-prescription medicines,  a Care Plan OR  Medication Consent Form signed by the PARENT ONLY is required.

All forms are provided below, or they can be requested from your school's health room.

>>Medication Consent Form 

>>Spanish Medication Consent Form

>>Medication Change Form

To obtain care plans please scroll to the bottom of this page.


Immunization Information and Forms

The Wisconsin Immunization Registry (WIR) is a secure computerized data system that tracks the immunizations given to people in Wisconsin.  Parents and legal guardians have access to look up their child's immunization record in the WIR.  To access the WIR:

  • Click on the link below
  • Look for the Public Immunization Record Access section
  • Click on Public Immunization Record Access
  • Enter your information, and search


WIR Link:   http://dhfswir.org

>>17-18 Immunization Form

>>Spanish Immunization Form

>>Wisconsin Immunization Requirements

>>Wisconsin Immunization Requirements - Spanish

Waukesha County Public Health Division provides immunizations to people of all ages on a walk-in basis no appointment is needed.  These immunizations are available at the Health & Human Services building, Public Health entrance, on Mon., Wed., Thurs., & Fri. (8 AM – 4:30 PM) with extended hours on Tuesdays (8 AM – 6:30 PM).  Call 262-896-8430 for an appointment or more information.


Important Vaccination Guidlines

If your child is insured, please make an appointment with your primary care provider for vaccinations.

If your child is Vaccines for Children (VFC) eligible, you can visit the Public Health Division clinics for vaccinations.

Who is VFC eligible?

Children through 18 years of age who are:

  • Medicaid eligible or enrolled
  • Uninsured
  • American Indian or Alaska Native 
  • Underinsured (has health insurance, but the coverage does not include all vaccines or only covers selected vaccines.  Speak with your private insurance company to check if your plan covers vaccines.)


The State of Wisconsin has a program titled Vaccines for Children (VFC).  This program is designed for children that are uninsured or underinsured as well as Native American and Alaskan Native to receive free vaccines.  For additional information please clink on the link below:

>>http://www.dhs.wisconsin.gov/immunization/vfc.htm

 


Vision and Hearing Information and Forms

>>Vision and Hearing Request Form

>>Vision and Hearing Exclusion Form

 

Health Care Plans

Our District Health Services team appreciates having a health care plan on file for any student who is diagnosed with a special health concern in order to safely administer the appropriate care while at school to your child.  This health information is shared with staff who have a legitimate need to know in order to care for your child during school day hours.  All student health information is treated confidentially.  Listed below are some of our most commonly used care plans.  Please fill out and have your physician sign (if a signature is required).  For all other health concerns/conditions, please use the Generic-General Health Care Plan.  Some students with complex medical needs have a specialized care plan prepared by the district nurse and will not need the forms below.  All care plans on file need to be updated on an annual basis. Please fill out the care plan to the best of your ability and sign the form.  Completed Care Plans can be mailed to the address below or brought to your school and given to the health assistant.  With a parent's signature on the form, school staff can fax the form to your physician for them to complete and sign. Thank you for your cooperation!

Mail Care Plans to:

Oconomowoc Area School District
Attn:  District Nurse
641 E. Forest Street
Oconomowoc, WI 53066

 

ADHD/ADD Care Plan- we are no longer requiring a care plan for students with ADHD or ADD.  Please update the District Nurse as medication changes occur.  If medicaiton will be admistered at school please fill out a Medication Consent Form

Care Plans by Type:

Asthma Care Plan

Diabetic Pump Care Plan

Diabetic Standard Care Plan

General Care Plan

Migraine Care Plan

Phy-Ed Care Plan (Please complete for any medical conditions requiring accommodations for PE)

Seizure Care Plan

Allergy Care Plans:

Allergy Care Plan - No Epi Pen (See Allergy Specific Care Plans Listed for Allergies with an Epinephrine prescribed)

Bee Sting/Insect Bite Care Plan

Food Allergy Care Plan

Latex Allergy Care Plan




Director Of Nursing Services: Lindsay Wojtasiak, RN, BSN 
641 E. Forest St., Oconomowoc, WI 53066 
Telephone: 262-560-2104
WojtasiL@oasd.org
Fax: 262-560-2106

W360 N7077 Brown Street
Oconomowoc, WI 53066
262-560-1115
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