School Nurse and Health Information

District Nurse

Robin Allen

Printable Medical Forms

​These forms are to be printed and taken to your child's physician to be signed. You must have adobe sign for the pdf's

• Individual Health Care Plan (Asthma) 1

• Individual Health Care Plan (Asthma) 2

• Individual Health Care Plan (Asthma) 3

• Individual Health Care Plan (Asthma) 4

• Individual Health Care Plan (Allergies) 1

• Individual Health Care Plan (Allergies) 2

• Individual Health Care Plan (Allergies) 3

• Individual Health Care Plan (Diabetes)pdf

• Individual Health Care Plan (Diabetes)word doc

• Individual Health Care Plan (Seizure) pdf

• Individual Health Care Plan (Seizure) word doc

• Health Questionar 

• Medication Administration Form A

• Inhaler Self-Administration Agreement

• School Asthma Response Plan

• EpiPen Permission Form

• Food Allergy and Anaphylaxis Plan

Important Links for Parents

• Information about mandatory TDAP Vaccines

• The Facts of Lice: How to prevent the spread of lice

• Letter to parents about flu and meningitis vaccinations 

Perry County Schools

105 Main St.

P.O. Box 137

New Augusta, MS 39462

Phone: 601-964-3211

Fax: 601-964-8204

MISSION STATEMENT 
 

     The Mission of the Perry County School District (PCSD) is to build a community of life-long learners by providing diverse educational opportunities.

VISION STATEMENT 
 

     To empower all stakeholders to become actively engaged in every aspect of the school community.