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Health Family Services

Parent Information

Annual Mass Flu Clinic: November 16, 2018

Genoa Central School District, with the help of the Arkansas

Department of Health (ADH), will be holding a Mass Flu Immunization

Clinic to provide flu vaccines to students free of charge. This clinic will

be held on Friday, November 16, 2018. If you want your child to

receive the vaccine, you must fill out and sign the 2 consents

provided. One consent is from the ADH (FRONT AND BACK) and

one is from Genoa School (FILL OUT THE BACK OF THIS LETTER).

The flu mist will not be available. The shot is the only form available at

this time. Also, please fill out the insurance information on the back of

the form. If you do not have insurance or if your insurance does not

pay for vaccines, there will still be no charge to you. Please return

these forms by Friday, November 02, 2018. The deadline will be

enforced this year due to changes in the ADH process of reviewing the

forms. Forms will not be accepted after the deadline. If you have

any questions regarding the flu clinic please call the Elementary office,

the Middle School office, or the High School office.



Arkansas immunization requirements:

Dtap:     4 doses with 1 dose after 4th birthday.

Tdap:     1 dose of Tdap for ages 11 (as of Sept. 1st of each year) and older.

Polio:      3-4 doses with 1 dose after 4th birthday.

MMR:     2 doses with dose 1 on or after 1st birthday and dose 2 at least 28 days after dose 1.

Hep A:    1 dose for kindergarten and 1st grade.

Hep B:     3 doses.

Varicella:   2 doses with dose 1 on or after 1st birthday and dose 2 at least 28 days after dose 1. A medical professional history of disease (chicken pox) may be accepted in lieu of receiving Varicella vaccine.

MCV4:     1 dose for 7th grade.  Second dose at age 16 years (as of Sept. 1st each year).1 dose if not vaccinated prior to age 16 years. (If 1st dose is administered at age 16 years or older, no 2nd dose required).  Must be received on or after 16th birthday.



Your Genoa Central Nursing Team


Kristi Wooten, RN


Elementary Nurse  


Rachel Hoover, RN


Middle School Nurse   


Amanda Green, RN


High School Nurse




Action plans are to be completed for Asthma, Food Allergies, Seizures, or Anapylaxis (other than food allergy). These forms should be completed yearly by the childs physician prior to the start of school and turned in to the campus nurse. 

Asthma Action Plan 

Food Allergy Action Plan

            Meal Modification Plan-Any student with food           allergy has to have this form completed by physician every year to keep on file in   cafeteria. 

Seizure Action Plan

Anaphylaxis Action Plan

Diabetic Management -For students with diabetes and does not have a diabetic medical management plan completed at physicians office, this form shall be completed by their physician. 

Catheter Order Form-  For students that require intermittent catheterization this form needs to be completed by the physician. 


Medication Administration Forms

If your child is to take medications at school, you must fill out the required paperwork. (This includes asthma inhalers.) Also if your child is given medication throughout the year (antibiotics, eardrops, etc.) to be given 3 times a day, you should give it before school, right after school, and at bedtime. This eliminates the possibility of the medicine being left at school and not accessible for other doses. Please click the links below for required medication paperwork. 

Medication Form-completed on all medications to me given at school.

Self Administration Consent Form-for students grades 5-12 that will carry and self administer asthma inhalers, epipens, or emergency glucagon.

Physician Order Form-To be completed by the childs physician yearly for ANY medication to be given at school. 

Epinephrine Administration Consent Form-Consent to give epinephrine in an emergency situation to a child with documented severe allergic reaction.

Glucagon & Insulin Administration Consent-Consent for nurse and TDP to administer insulin and glucagon as ordered by physician. 

Glucagon Carry Consent-For students grades 5-12 that will carry own emergency glucagon to be given in an emergency situation by nurse or TDP. 

Admission Forms

Authorization to Treat a Minor- This form MUST be completed on all students. If this form is not completed the student will not be allowed to attend ANY field trips. 

Kindergarten Physical Forms- This form MUST be completed on all new kindergarten students.

Athletic Physical Forms

Athletic Physicals

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