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DC Universal Health Certificate [] - Annual Form providing updates on the child's physical health status and updated immunizations. Pages 2-4 must be filled out by a medical professional.


School Health Services Program - [] Review of programs, policies, and procedures for receiving health suite services. Aimed at creating a deeper understanding of health suite protocol and consent for students to receive screenings including vision, dental, and hearing as needed.


School Health Telehealth Program Consent Form [] - Consent for your child to receive telehealth care from Children's School Services AKA Childrens National Hospital. 


Consent to Share Student Health Education Records [] - Consent for nurses to share educational health records with key DCPS staff to better provide for the needs of your child.


Immunization Requirements []- Informational list of required immunizations by DC Health for all school-age children 


Immunization Opt-out Information []- Information for religious or medical exemptions with details on applying and submitting


DC Health Oral Health Assessment Form [] - Report oral health status or information on the most recent visit


School-Based Oral Health Program Consent Form [] - Consent to the annual DCPS school-based oral health program. Each year a Dentist comes to Leckie and provides dental screenings and services to students during school 


Medical Plan/ Procedure Form [] - Outlines student needs for medication and or. a medical procedure plan


Asthma Action Plan [] - Outlines a student's asthma needs, severity, triggers, and action plan for treatment 


Anaphylaxis Action Plan [] - Outline a plan if your student has an allergic reaction that may require an epi pen 


Medical Dietary Accommodation Form [] - If your student requires a special meal plan, related to a medical condition or food allergy, this form must be completed and emailed to DCPS Food and Nutrition Services (FNS) at: A new form must be submitted each time a dietary change is requested. 


Milk Substitution & Philosophical Dietary Accommodations Form []- If your student requires a milk substitution related to lactose intolerance or requires a special meal related to religious/philosophical food preferences, this form must be completed and emailed to DCPS Food and Nutrition Services (FNS) at:

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