Medical Forms

The TCCBED and Archdiocese of Galveston/Houston office requires that all students have a Student Emergency Information Card, TB Questionnaire, Pre-Participation Physical Evaluation Form along with an up-to-date Immunization Record on file. Please click on the links below.

            Student Emergency Information Card
            TB Questionnaire
            Pre-Participation Physical Evaluation
            Immunization Policy

 

If  your student has any condition that requires intermittent or ongoing treatment, please complete the corresponding form from the list below:

            Medication Permission
            General Illness Action Plan
            Asthma Action Plan
            Diabetes Action Plan
            Food & Life-Threatening Allergies Action Plan
            Student Seizures Form

 

 

3 and 4 year olds:

• Polio – 3 doses
• DTP/DTaP – 4 doses
• MMR – 1 dose on or after 1^st birthday
• HIB – 1 dose on or after 15 months unless a primary series and booster was completed prior to, or at, 15 months of age.
• Hepatitis A – 2 doses
• PCV7 - 2 doses

*It is recommended that DPT/Polio and 2^nd MMR be given as soon as possible after the 4^th birthday. They are required by the 5^th birthday. Varicella – 1 dose if born after September 2, 1994.

5 and 6 year olds:

• Polio – 3 doses with one on or after the 4^th birthday.
• DTP/DTaP/TD – 4 doses with one on or after the 4^th birthday.
• MMR – 2 doses – first given on or after the 1^st birthday and second given no sooner than 28 days from the first doses.
• HEPITITIS B – 3 doses
• Varicella – 1 dose

7 Year olds:

•  Polio – 3 doses with one on or after the 4^th birthday.
• DTP/DTaP/TD – 3 doses any combination with one received on or after the fourth birthday.
• MMR – 2 doses – first dose given on or after the first birthday and second dose no sooner than 28 days from the first dose.
• HEPITITIS B – 3 doses if born after September 2, 1992. It is recommended for all students.
• Varicella – 1 dose if born after September 2, 1994.

 

Middle School requirements are:

• DTP/DTaP – 3 doses (any combination) with one dose on or after the fourth birthday and within the last ten years.
• Polio – 3 doses with one dose after the fourth birthday.
• MMR – 1 dose on or after the first birthday and a second dose by the 12^th birthday if born between September 1, 1978, and before September 1, 1991.
• Hepatitis B – 3 doses.
• Varicella – 1 dose if born before September 2, 1994.