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Franklin Learning Center

Franklin Learning Center

School District of Philadelphia
  • Home
  • About Us
    • FLC Vision & Mission
    • FLC at a Glance
    • School Calendar
    • Counselor’s Homepage
  • Keystones
  • Admissions to FLC
    • FLC Admissions Criteria
  • FLC Majors
    • Art Major
    • Business Administration Major
    • College Prep Major
    • Computer Science Major
    • Dance Major
    • Medical Clinical Assistant Major
    • Music/Drama Majors
    • Academics for Current Students
  • Sports
    • FLC Athletics
    • Additional Forms and Info
  • FLC Clubs
  • For Parents
    • Medical Forms from the Nurse
    • Other Forms
    • Family Educational Rights and Privacy Act (FERPA)
  • Academics for Current Students
  • School Nurse Information
    • School Nurse Information
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    • Health Room Hours
  • FLC 2025-2026 School Supply List
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  • From the Nurse- Medical Forms & Immunization...

From the Nurse- Medical Forms & Immunization Requirements

Posted on October 8, 2020
Categories: Nurse, Parents

Student Medical/Emergency Google Form

Student Medical/Emergency Printable Form

SEC-137A Physician’s referral for homebound instruction (PDF)

M-152A Medical transportation request- Physician certification (PDF)

Self-Medication Assessment Tool (PDF)

Medication / Equipment Received in School (PDF)

Release of Information Form

Med-1-Seizure

MED-1-Asthma

Immunization Flyer – ALL Grades

Report-of-Physical-Examination-Form_MEH1-1

Med-1

MEH-155

Student Mask Accommodation Form

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Commonly Requested Forms for Parents & Students

Physical Exam Report

Request for Administration of Medication

Request for Administration of Asthma Medication

Request for Administration of Seizure Medications

Report of Private Dental Exam Form

Physical Education Medical Exemption form

OHIP Consent Form

S-865 Student Emergency /Medical Information (PDF)

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    616 N. 15th St.
    Philadelphia, PA 19130

    call us at215-400-7570
    Grades: 9-12
    Principal: Mrs. Nicole Lee

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