Health Forms for Schools

The following forms are for school nurses and health technicians. Click on any of the following links. A new window will open with the chosen form. Save the document to your computer or print.

Instructions for forms below and resources

• Medication Administration Record 2024-25 Jul-Jun

The following forms can also be found on the Ventura County Self-Funding Authority Forms page

• Medication Administration form (English) - VCSS SFA-5010
• Medication Administration form (Spanish) - VCSS SFA-1059b
• Medication Administration form - Multiple Medications - VCSS SFA-5030
• Readmission to School of Student with Temporary Disability/Injury - VCSS SFA-5110
• Reasmission to School of Student with Temporary Disability/Injury - VCSS SFA-5110S - Spanish
• Controlled Substance Count - Sample form in Word document for editing
• Medication Login - Sample form in Word document for editing