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Central Dauphin School District

600 Rutherford Road Harrisburg, PA 17109 • 717.545.4703

Quality to the Core

Authorization for School Medication

DPS-232 Authorization for School Medication.pdf 139.56 KB (Last Modified on August 23, 2023)

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Annual Health Survey Form

The information requested on this form will be of help to the school nurse in determining the health status of your child and in assisting him/her to receive maximum benefits from his/her educational opportunity.

DPS-236 Annual Health Survey_DPS-228 OTC form combo.pdf 186.15 KB (Last Modified on August 23, 2023)

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Epinephrine Proficiency Checklist

Epinephrine Proficiency Checklist

DPS-235 Epinephrine Delivery System Skills Checklist.pdf 120.96 KB (Last Modified on August 23, 2023)

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Inhaler Proficiency Checklist

Inhaler Proficiency Checklist

Inhaler Proficiency Checklist.pdf 46.88 KB (Last Modified on December 5, 2013)

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Pennsylvania Private Physician's Report

Pennsylvania Private Physician's Report of Physical Examination of a Pupil of School Age

PrivatePhysicianForm.pdf 3.09 MB (Last Modified on September 22, 2010)

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Pennsylvania Private Dentist Report

Private Dentist Report of Dental Examination of a Pupil of School Age

PAprivatedentalform.pdf 202.27 KB (Last Modified on September 22, 2010)

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Permission to Carry an EpiPen

Permission to Carry an EpiPen

EpiPen permit formRevMarch_2014.pdf 108.68 KB (Last Modified on March 19, 2014)

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Secondary Adaptive PE form

Secondary Adaptive PE form

Secondary Adaptive PE form.pdf 67.29 KB (Last Modified on December 5, 2013)

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