It is important for all students to be healthy so they are ready to learn to reach their full academic potential.  State law and school board policies require specific health documentation for certain grade levels.  Please see below for the required health documentation forms and to learn more about our health services.  

The Role of the School Nurse

The school nurse serves all students who attend Charles City Schools.  A school nurse is a licensed health professional who serves students in a school setting who can provide assessments, education, delegation, interventions, and outcome evaluation.  The school nurse serves as a collaborative partner in the educational process. 

Some students may need an individualized health plan written by the school nurse.  If your student has a health condition that requires any of the following, please contact the school nurse:
  • Safety precautions (bus, playground, gym, lunchroom)
  • Assistance with activities of daily living (dressing, toileting, feeding)
  • Medication (daily medication, inhaler, seizure medication, insulin)
  • Medical supplies
  • Specific equipment or appliances
  • Prosthetics including limbs and devices
  • Mobility devices
  • Emergency Evacuation Plan
  • Modified dietary needs
The Role of the Health Associate

Charles City Schools employs two health associates to assist our school nurses to meet the health needs of our student's district wide.  Health associates assist in the daily operations of our health offices, provide first aid, and receive extra training by the school nurse.  Our health associates work closely with the assigned building school nurse as an essential team member. 

If you would like to fax your completed forms, please use the fax numbers below:

Washington Elementary 641-257-6573

Lincoln Elementary        641-257-6562

Middle School                641-228-9842

High School                   641-257-1175

Immunization Information

Immunizations are important and Iowa law. All students need an immunization certificate, specifically grades PS, K, 7th & 12th. Please make sure your child’s immunizations are up to date and provide a current copy to your child's campus.  You can receive immunizations from your local physician or contact Floyd County Public Health Department at 641-257-6111. 

State of Iowa Immunization Requirements 

Medical Exemption for Immunization Form

Religious Exemption for Immunization Form

Medication Policy

Some students may need to carry medication (inhaler, EpiPen) and this requires the written permission of the parent and the physician. All other medications will be administered by certified staff as the prescription calls for. 

The school can only accept medications in the student’s own labeled prescription bottle or in the original “over-the-counter” container. The school will accept a written parental request with a properly labeled bottle of medication for the first day.  A school request form will be required before any further doses of medication will be administered. Contact your student's campus for details. 

The PARENT, not the student, needs to transport ALL scheduled medications (ADHD drugs, opioids, Tylenol) to school.

The prescription label and the medication request form must match. The parent must fill out a new medication sheet with any medication change as well as provide a corrected label for the medication bottle. Our front-of-house staff will help you with this paperwork. 

Medication prescribed three times a day will be given OUTSIDE of school hours unless ordered by a physician for a specific time during school hours. We also request that you only bring medication to school that is absolutely necessary.  Once a day medications can be given at home.

Requests for as-needed medications such as Tylenol, decongestants, antihistamines, etc. will be granted on a short-term basis.  A physician order may be requested should usage be deemed excessive by the nurse assessment.

The parent cannot request “over the counter” medication dosage greater than the label directive. 

Medication Self-Carry Form

Medication Consent Form

When is a child too sick for school?

 Iowa Health and Human Services Childhood Illness Criteria

Deciding when a child is too sick to go to school can be difficult. In order for your child to be available for learning and to  control communicable diseases in school, it is important to keep your child home for the following reasons: 

Fever 100.4 degrees and above 

Your child should be fever free and off all fever-reducing medications for 24 hours before he/she returns to school 

Sore Throat 

A minor sore throat is usually not a problem, but a severe sore throat could be a symptom of a more serious illness. If your child is diagnosed with strep throat he/she may return to school 24 hours after antibiotic treatment begins. 

Vomiting and Diarrhea 

Your child should stay home until the illness is over (without the use of medication) and for 24 hours after the last episode of vomiting/diarrhea.

Influenza, COVID-19 and RSV symptoms 

This includes sudden onset of high fever, chills, headache, body aches, dry cough, or vomiting. Influenza can be serious and may warrant immediate medical attention. Your child should stay home until the illness is over without the use of medication. Your child must also be fever free without the use of fever-reducing medication for 24 hours before returning to school.  


Head lice infestations are common and are most likely to occur in preschool and elementary-age students, regardless of socioeconomic status or geographic region. A head lice infestation is not a communicable disease and no health risks have been associated with head lice. 

If your child is found to have head lice by the school nurse, contact will be made with the parent/guardian. The school nurse will provide the parent/guardian with evidence-based education and treatment instructions from the Iowa Department of Public Health. Students do not need to be sent home or miss school due to head lice; however, it is recommended that parents/guardians begin treatment as soon as possible before their child returns the next day. 

Both the American Academy of Pediatrics (AAP) and the CDC recommend schools discontinue the following practices: whole classroom head lice screenings, exclusion for nits or live lice, and notification to others except for parents/guardians of students with head lice infestations. Notification to others may be a breach of confidentiality.

Head Lice Brochure

Preschool Health Forms

Preschool Physical Form

Dental Screening Form

Vision Screening Form

Kindergarten Health Forms

Kindergarten Physical Form

Dental Screening Form

Vision Screening Form

Lead Screening Information

3rd Grade Health Forms

Vision Screening Forms

9th Grade Health Forms

Dental Screening Form

Nursing Interventions for Chronic Health Conditions

Asthma Action Plan

Diabetes Action Plan

Food Allergy Action Plan

Seizure Action Plan

Downloadable forms

Diet Modification Request for Foods Served Through Child Nutrition Programs