Strathmoor Pediatrics

Pediatric Medical Office

  • Closed!
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  • Map and Directions
  • Office Policies
  • Calendar/Events
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  • Contact Us
  • Patient Education Materials

JCPS School Forms & Info

This page is to help provide a copies of the most used Kentucky Department of Education (KDE) and Jefferson County, Kentucky Public School (JCPS) forms that the physician may be required to complete on the behalf of a patient. Should a form not be present here, please visit the JCPS Web Site or the KDE Web Site to find the appropriate form.

Physical Exam

  • Athletic Participation Information
  • KDE School Physical Form
  • KHSAA Sports Physical Form

Medical

  • Asthma/Allergy Form
  • Diabetes Form
  • Feeding/Swallowing/G-tube Form
  • Respiratory Form
  • Seizure Form
  • Other Health Conditions Form

Dental

  •  Dental Screening Form

Vision

  •  Vision Examination Form

Miscellaneous

  • JCPS School Year Calendar
  • Norton Concussion Card
  • Concussion Statement
  • Athletic Manual
  • Athletic – Parent Permission Form
  • School Health Exam Parent Permission
  • Authorization to Give OTC Medications
  • Authorization to Give Prescription Medications
  • Photo/Video Tape Release Form
  • Sports Safety Video Form
  • Sports Safety Course Guide
  • KHSAA Heat Injury Information
  • Certificate of Medical Exemption
  • Certificate of Religious Exemption

Kentucky Regulations

  • KRS 158.160 –Voluntary Compliance
  • KRS 214.034 – Immunization of Children
  • KRS 158-035 – Certificate of Immunization
  • 42 C.F.R. § 440.110 – Therapy Services

This list is by no means comprehensive. Should there be an error or blatant omission, please inform us immediately.

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