Medical Registration Forms

2023—2024 School Year

MSD has moved from paper forms to an online registration system. You will access and fill out your child's registration information through PowerSchool. In case you are unable to access some forms online, blank hard copies are provided below on this webpage to print and complete. However, there are some medical forms which will need to be downloaded, printed, and filled out by you and your child's doctor. These medical forms can be found below on this webpage. Should you have any questions or need your parent access id or password, please contact [email protected].

Health Forms (must be printed)

Registration of Physical Examination Form

The Registration of Physical Examination form is good for one year.

- Physical Exam Part I (to be completed and signed by a parent or a legal guardian)
- Physical Exam Part II (to be completed and signed by a Healthcare Provider, including the last page which indicates whether or not your child is cleared for sports)

Immunization Certificate - DHMH896

The Immunization Certificate form is to be completed ONLY if recent vaccines were received or if your child is a new student at MSD.

Blood Lead Testing Certificate

The Blood Lead Testing Certificate form is for all preschool, kindergarten, or first grade students only. This form is to be completed only once.

Other Health Forms to be printed and completed every year if applicable to your child:

School Medication Administration Authorization Form

One School Medication Administration Authorization form must be completed for each prescription, over-the-counter medication, and supplement/vitamins, etc.

Asthma Medication Administration Authorization Form

The Asthma Medication Administration Authorization form must be completed if your child has asthma.

Anaphylaxis Emergency Action Plan

The Anaphylaxis Emergency Action Plan must be completed if your child is at risk for anaphylaxis or a severe allergy.

Diet Modifications for Children with a Food Allergy or Other Disability Form

The Diet Modifications for Children with a Food Allergy or Other Disability form must be completed if your child has food allergies or sensitivities.

Gastrostomy Tube Feeding/Treatment Authorization Form

The Gastrostomy Tube Feeding/Treatment Authorization form must be completed if your child has a G-tube.

Seizure Action Plan

The Seizure Action Plan form must be completed if your child is at risk for seizures.

Catheterization (CIC) Authorization Form

The Catheterization (CIC) Authorization form must be completed if your child needs to be catheterized.

Diabetes Medical Management Plan

The Diabetes Medical Management Plan form must be completed if your child has diabetes.

Emergency Action Plan: Sickle Cell Crisis

The Emergency Action Plan: Sickle Cell Crisis form must be completed if your child has sickle cell anemia.

Questions

If your child has a medical issue or concern not listed on this webpage, please contact the MSD's Student Health Center at [email protected] or [email protected] for a specific form.

For More Information

For more information on the Student Health Center services at MSD, please visit www.msd.edu/studenthealthcenter/.

For questions, please contact:

Alyssa Myers, RN | Registered Nurse Supervisor, Columbia Campus

Email: [email protected]

Kimberly Ward, RN | Registered Nurse Supervisor, Frederick Campus

Email: [email protected]