Resources » Required Health Forms

Required Health Forms


Hello and thank you for helping Duchesne Academy and its faculty and staff provide the best possible care for your student(s).


Here you will find a folder with a specific health condition noted. Please open that folder and complete all forms within that folder.


  • The “update” form in each health condition folder is completed annually to gain the most current and accurate information regarding your child’s health needs. Your cooperation is very important. The completed “update” provides student-specific information to guide Duchesne personnel in case your child experience difficulties related to their medical condition at school or during Duchesne activities. Parents/guardians should complete the update form and have it signed by your child’s physician. Thank you for returning the following “update” forms to school promptly.
  • The “Emergency Action Plan” in each folder is a reference as it will be followed if your child experiences difficulties related to their medical condition at Duchesne.
  • The “Medical Authorization” form is for any medication, prescription or over the counter, that needs to be filled out if this medication is taken by the student during school or school activities.
  • The “DHHS health release” forms are state-mandated forms for the student’s self-management of various health conditions at school.
  • If you reside out of the state of Nebraska, you need to complete the vision and physical form for your daughter per state regulations. The school needs verification of a physical and a vision exam if you live out of state, but will take any physical or vision form provided by your physician.


    • If your daughter plans to try out for a sport at Duchesne, please click here for additional paperwork required for sports participation.
    • Questions in regard to Athletic Paperwork, contact: Kevin Van Winkle, [email protected]


If you have questions or feel your child’s emergency action plan requires adaptation, you may email school nurse, Madeline Quinn at [email protected] for assistance.


Madeline Quinn, BSN, RN, CPN, CCRN Children’s Hospital and Medical Center