Elkhart and St. Joseph Counties Head Start Consortium
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Health All Forms

HEALTH
DASHBOARD

All Forms

Health Care Plans

Medication Administration MAR Record 24-25Download
Parent Permission for Medication English/Spanish 24-25Download
Individualized Health Care Plan 24-25Download
Rejected Medications 24-25Download

Incident Reports

Accident Incident Report 24-25Download

Medical Forms

Dental Form 24-25Download
Hemoglobin Screening Letter Parent 24-25Download
Immunization Letter Physician Letter 24-25 docxDownload
Parental Declination of Child Vaccination 24-25Download
Right to Refuse Services 24-25Download
WELL CHILD EXAM 24-25Download
Family Services Referral Form 24-25Download
Medical Statement Food Allergy Restriction Plan 24-25Download
TB TDAP Form 24-25Download

Prenatal and Post Partum Packet

EHS Prenatal Information form 24-25Download
Newborn Health Visit Appendix A 24-25Download
Prenatal_Post Partum (Physician Letter) 24-25Download
Child Birth Record 24-25Download
Prenatal Post Partum COVER English Spanish 24-25Download
Prenatal Exam EHS 24-25Download

Screenings and Assessments

EHS Daily Record Sheet (Revised 5.14.24) 24-25Download
Hearing Screening Form 24-25Download
Screening Authorization Release Form English Spanish 24-25Download
Vision Screening Form 24-25Download
Vision Snellen Eye Chart InstructionsDownload

Things to Post

Classroom (EHS HS) Postings Packet 24-25Download

© Elkhart and St. Joseph Counties Head Start Consortium 2025 | Designed by Compulse Integrated Marketing
The Head Start Program is a federally funded school readiness program that offers cognitive, social, and emotional development skills to children up to five years old. Head Start provides services to low-income families located in Elkhart and St. Joseph County schools including; Baugo, Concord, Elkhart, Goshen, John Glenn, Middlebury, Mishawaka, Penn-Harris-Madison, South Bend, Union North, and Wa-Nee, Indiana.