 School
Health Program
Forms
You can search for the following forms here.
Physical Exam Report -
Form # FH-42
Physical Exam Certificte -
Form # FH-43
Visual Evaluation Report -
Form # FH-41
Physical Exam and Visual Eval Waiver -
Form # FH-40
Health History Child -
Form # FH-23
Health History Adolescent -
Form # FH-5
Self-Management Diabetes -
Form # FH-25
Self-Managment Diabetes Asthma -
Form # FH-31
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For More Information Contact:
Kathy Karsting, RN, MPH
School & Child Health Program Manager
P.O. Box 95026
Lincoln, NE 68509-5026
Phone: (402) 471-0160
Fax: (402) 471-7049
email: kathy.karsting@dhhs.ne.gov
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Adolescent Health Page
Lifespan Health Page
Health & Wellness Page |
