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Medical Forms

Medical Authorization Forms

  • Authorization for Medicines (PDF Format)
    Authoization to administer medication/health procedure/treatment to my child. I agree to provide a new physician’s order if there is any change in medication, dosage, administration time, or procedure/treatment. I agree to furnish all equipment, supplies, medications, formulas, or other necessary items and to provide replacements and maintenance as necessary.
  • Participation Physical Evaluation Form (PDF Format)
    Physical Evaluation Form for Sports Participation.
  • Authorization to carry Prescription Inhaler (PDF Format)
    Authorization to carry a Prescription Inhaler
  • Medical Recommendation-Phys./Provider Order(PDF Format)
    In order to better serve this child’s educational needs, we would appreciate your cooperation in providing any precautions, special considerations, recent or upcoming surgical procedures, and/or medications that the student may need (activities, diet, equipment, etc.)
  • Immunization Procedures (PDF Format)
    The Georgia Certificate of Immunization (form 3231) is a form provided by the Department of Human Resources. It is issued by a physician licensed under the laws of Georgia or by a local board of health (Health Department).
  • Student Information Form (PDF Format)
    Every student, regardless of school will need this form completed yearly. This gives the school updated contact and health information.
  • Medicaid Consent & Release Form (PDF Format )

Contacts

Kathy Wood
Lead Nurse
(912) 212-8573
kwood@bulloch.k12.ga.us

Sheila Hutchens
Medicaid Clerk
(912) 212-8574
shutchens@bulloch.k12.ga.us