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FHS - Nurse's Office - HYBRID STUDENTS - SPR/SUMMER 2021
STUDENTS!
Student's please take a few moments to complete the information below for any student that needs to go to the nurse's office.
-Administration
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* Indicates required question
Grade Level
*
Choose
9th
10th
11th
12th
Option 5
Name (Last)
*
Your answer
Name (First)
*
Your answer
SLC or School
Choose
LSJ
MAGNET
MSA
SGMA
Student Advisory Teacher
Choose
Mr. Martinez
Ms. Constanza
Ms. Randall
Mr. Ramos
Mr. Gray
Ms. Aguilar
Ms. Allshouse
Ms. Averiette
Mr. Cooper
Mr. Cruz
Mr. Dumlao
Mr. Farley
Ms. Flores
Ms. Frangia
Mr. Godinez
Ms. D. Jones
Ms. P. Jones
Mr. Lopez
Mr. Maduabuchi
Option 20
Ms. Michael
Ms. Monugian
Ms. Nguyen
Ms. Ortega
Ms. Patel
Ms. Rodriguez-Pequeno
Ms. M. Rodriguez
Ms. Rojas
Ms. Talebi
Ms. R. Thornton
Mr. Trinidad
Ms. Ikediashi
Mr. Smith
Option 34
Option 35
Teacher First & Last Name(if not shown in drop-down box)
Your answer
Symptoms
*
Choose
Headache
Chronic Cough (i.e.congestion, runny nose, sore throat)
Shortness of Breath (Asthmatic)
Stomachache
Musculorskeletal Injury
Nosebleed
Pink eye
Attempted Classroom Interventions
*
Rested for 15 minutes
Used the restroom
Drank water
Rinsed eyes
Applied ice pack
Elevated Extremity
Held pressure with head down fr 15 minutes (nose bleed)
Administered medication
Required
Notes: (i.e., time medication was issues, etc.)
Your answer
Thank you for your entry.
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