PATOKA CUSD 100

PATOKA PRIDE

To access each form, click on the listing below and print.  If at any time there are questions on one of the medical forms, please contact our School Nurse.

School Immunization Summary for Patoka School District 2022-2023

2024-2025 School Year Medical Requirements

School Physical Form (Certificate of Child Heath Examination)

Sports Physical Form

Dental Providers that Accept Medicaid

Eye Exam Form

Dental Exam Form

Physician Statement for Food Substitution Form

Lead Risk Assessment Form

School Medication Authorization Form

P.E. Excuse Form

Authorization for Exchange of Confidential Information Form

Patoka School's Concussion Protocol

Concussion Symptom Checklist Form

When to Keep your Child at Home!  Fact Sheet

Checklist for Eliminating Headlice