Health Forms
To ensure the health and safety of all students enrolled at Admiral Farragut Academy, an annual physical exam and clearance from a health care provider is required. Physical exams on file may not be older than 12 months at any given point during the school year for a day or boarding student to participate in physical education, athletics, club and other school activities on and off campus.
Additionally, a Prescription Medication Authorization form must accompany any prescription medications to be administered by the Health Center nurses or their designee. The first dose of any prescription medication should, if possible, be administered at home.
The required Health forms are:
- All new and returning K-5 students
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- State of Florida School Health Entry Exam (DH3040)
- Complete immunization record
- Health insurance information form
- If you expect a change in insurance between now and the start of school, please wait to submit this form until changes have been made.
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- All new 6-12 students
- PreParticipation Physical Evaluation (EL2)
- Complete immunization record
- Health insurance information form
- If you expect a change in insurance between now and the start of school, please wait to submit this form until changes have been made.
- All returning 6-12 students
- PreParticipation Physical Evaluation (EL2)
- Complete immunization record – GRADE 7 ONLY
- Health insurance information form
- If you expect a change in insurance between now and the start of school, please wait to submit this form until changes have been made.
Supplemental Health Forms to be completed if applicable:
- If your child will need medication administered at school, please have the prescriber complete the:
- If your child has food, insect or other allergies requiring emergency medication such as diphenhydramine (Benadryl) and/or epinephrine (Epipen), please have your child’s health care provider complete and sign the
- If your child has asthma requiring emergency medication such as an albuterol inhaler, please have your child’s health care provider complete and sign the
Completed forms should be returned to the Health Center
no later than Monday, August 1, 2022.
If you are unable to meet the August 1st deadline, please contact the Health Office via email, nurse@farragut.org, and it will be noted in your child’s file.
Completed forms can be:
- Emailed to nurse@farragut.org or
- Faxed to 727- 384 -1132 or
- Hand delivered to AJ Barmmer in the DeSeta Hall reception office.
As an FYI, the following Health forms along with some other non-health school forms will be sent to you via email and should be electronically completed, signed and submitted. You DO NOT need to print and complete the forms below.. This is only for your information. Please complete and submit electronically when received.
- Consent to Treat
- Health Summary
- Authorization for Over-the-Counter medications
Please feel free to contact me with any questions or concerns.
Suzanne Douglass, RN, BSN
Director of Health Services
Admiral Farragut Academy
727-384-5506
