HCS Medication Form

HCS Medication Form
The HCS Medication Form lets parents and guardians complete the student portion online. After filling it out, the form needs to be printed, signed by the student’s physician, and submitted to the school.
School*
STUDENT INFORMATION
Student's Full Name*

First NameMiddle NameLast Name
Student's Date of Birth*

MonthDayYear
Date
Homeroom Teacher*
Current Grade Level*
Medication Allegrgies*
DOWNLOAD AND PRINT THIS FORM
Please click DOWNLOAD AND PRINT below to download the PDF with your student's information. Please print one form for each medication.
Should be Empty:

DOWNLOAD AND PRINT THIS FORM