Medical & Health Forms

All OUSD health forms are available in the right column on this page or on the OUSD Health Forms Page.

Vaccinations

All families are required to provide documentation verifying that their student has met state requirements for school immunizations.

For students entering 7th and 8th grade, documentation must include 2 doses of the Varicella (chicken pox) vaccination as well as the Tdap booster shot in addition to the other school required vaccinations.

Health Vaccination Requirements for School

Regarding Covid vaccination requirements, I do not know if/when they will be required but the district will be providing updates.

Students with medical conditions and/or needing access to medications during school hours:

The applicable form(s) should be completed, signed, and dated by both a medical provider and the parent. Copies of common school medical forms are attached at the bottom of this email. These forms need to be renewed annually.

If families would like to authorize their child to self-carry/self administer medications such as inhalers, epipens, over the counter medications for cramps/headaches/allergies/medicated creams/ointments, etc. make sure the appropriate box on the form is checked.

If families would like to have medications or a back-up supply kept in the nurse's office, please have an adult deliver the medication(s) to the school in the original, labeled container from the pharmacy along with the completed medical orders.

Controlled substances may not be self-carried and must be kept in a locked place at the school. A designated trained staff member will assist any student requiring access to controlled substances (such as ADHD medications) during school hours.

Completed form(s) can be emailed to Nurse Hurt at elizabeth.hurt@ousd.org or hard copies of the form(s) may be delivered to the school to be given to the school nurse for review and processing.

I will be checking my work emails as we near the beginning of the 2022-23 school year. Feel free to reach out with any questions or concerns.

If you require immediate assistance please contact Health Services at (510) 879-2742

Nurse Hurt

Authorization_for_Medication_0712.doc (to be completed and returned to school nurse if bringing medication to school)

Asthma Action Plan English and Spanish (to be completed and returned to school nurse if student has asthma)

PTO Forms:

Link to PTO Forms (PTO Check Request Form and Mini-Grant Application)

OUSD Health Forms

Immunization Forms

1. Parent Health Requirements Letter

2. Report of Health Examination for School Entry (English/Spanish)

3. Free/Reduced Cost Immunization Clinics

Dental Forms

1. Oral Assessment Form (English)

2. Oral Assessment Form (Spanish)

3. Alameda County Community Dental Resources Pamphlet

4. Alameda County Dental Resources - Medi-Cal Providers

Medication Form

1. Authorization for Medication

Diabetes Form

1. Diabetes Medical Management Plan

Asthma Forms

1. Asthma Action Plan

Severe Allergies Forms

1. Severe Allergy Action Plan

OUSD prohibits unlawful discrimination (such as discriminatory harassment, intimidation, or bullying) against any student, employee, or other person participating in district programs and activities, including, but not limited to, those programs or activities funded directly by or that receive or benefit from any state financial assistance, based on the person's actual or perceived characteristics of race or ethnicity, color, ancestry, nationality, national origin, immigration status, ethnic group identification, age, religion, marital, pregnancy, or parental status, physical or mental disability, medical condition, sex, sexual orientation, gender, gender identity, gender expression, or genetic information, or any other characteristic identified in Education Code 200 or 220, Government Code 11135, or Penal Code 422.55 or equity or compliance with Title IX, or based on his/her association with a person or group with one or more of these actual or perceived characteristics (5 CCR 4610). BOARD POLICY 0410. BOARD POLICY 1312.3. BOARD POLICY 4030. BOARD POLICY 5143.3. BOARD POLICY 5145.7. Complaint forms are available at school sites, on the district webpage at www.ousd.org/ombudsperson, at the Office of the Ombudsperson located at 1000 Broadway, 1st Floor, Suite 150, Oakland, CA 94607, via email at gabriel.valenzuela@ousd.org, or via telephone 510-879-4281.

Montera Middle School

Be Safe. Be Kind. Be Responsible.

Downloadable Forms

Medical & Health Forms

Vaccinations

PTO Forms:

OUSD Health Forms

Address

Phone

Fax