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  1. JCS
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  3. Nurse's Corner
  4. Health Forms
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Health Forms

Click below to access forms needed for care and treatment in the Nurse's Office. Click on the appropriate form, at this time you will need to print the form and bring to the school or fax to me at 517-849-7306. If you have any questions please contact Tina Varney, RN at 517/826-7114.

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Authorization for Treatment and OTC Medications

Williams Elementary

Jonesville Middle School

Jonesville High School

Jonesville Pathways

Jonesville Pathways Spanish versio

Authorization for Routine/Short Term Medications

Authorization for Routine/Short Term Medications Spanish

Asthma Action Plan

Parent/Student Agreement to Carry Inhaler

Food Allergy Action Plan

Michigan Dept. of Ed Food Allergy Form

Severe Allergy Action Plan

School Plan for a Student with Diabetes

Diabetes Medication Authorization Form

School Plan for a Student with a Seizure Disorder

School Plan for a Student with a Tracheostomy

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Jonesville Community Schools
115 East St.
Jonesville, MI 49250
Phone: (517) 849-9075
Fax: (517) 849-2434

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