Health forms are a necessary process when it comes to enrolling your child in school, sports, camp, or other physical activities. We are striving to make your lives easier when it comes to these forms. With our updated process you can expect the following:
- Easier completion & submission
- Faster turnaround time
- HIPAA compliant & secure
- Increased reliability from start to finish
Follow these easy steps:
- Pick the correct health form below that pertains to your child
- Electronically complete the parent section of the form
- Required fields must be completed in order to submit your forms
- Digitally sign your form and hit submit.
- Check your email and verify your digital signature.
- Immunization records are attached to all health forms and have a Potomac Pediatrics stamp. Due to the nature of this process, we do not “sign” the form but the stamp constitutes an official record.
After you’ve submitted your forms (via verifying your digital signature) they will immediately drop into our queue for completion. When your forms are completed, you will immediately receive a finalized copy in your email.
Do you need just an immunization record? If so please email us at email@example.com with your child’s name and date of birth.
In order for Potomac Pediatrics to complete health forms for your child, they are REQUIRED to have a physical within the past 12 months. You can verify if your child is up to date by logging into your patient portal and checking their appointment history or by contacting our office. Any request for health forms received for a patient that does not have an up to date well exam will be declined. Forms submitted prior to a scheduled well exam will be held until the appointment occurs at which time we will complete the requested forms. Please note that completion will not occur at the time of the appointment.
Bullis Health Forms
Bullis School Physical Examination Form
Bullis School Asthma Action Plan & Authorization
Bullis School Allergy Action Plan
Boy Scouts Camp
Camps Airy and Louise Medical Forms
JDS Health Forms
JDS Sports Physical Examination
JDS Authorization to Administer Prescribed Medication
JDS Non-Prescription Medication Authorization
JDS Anaphylaxis/ Severe Allergy Action Plan
JDS Asthma Action Plan (The ALA Asthma Action Plan form is the preferred form for JDS)
Maryland State Forms
Maryland State Health Inventory Form
(OCC1215) MD State Health Inventory Childcare Form (For most Daycares and PreSchools)
Maryland State Childcare Medication Authorization Form
Maryland State Asthma Medication Authorization Form
Maryland State Asthma Action Plan Form
Maryland State Lead Form
Maryland State Child Care Asthma Medication Administration Authorization Form
Maryland State Allergy Action Plan Form
Maryland State Emergency Form
Maryland State Medication Administration Authorization Form
Montgomery County Health Forms
MCPS R-6 Student Record Card 6
- If your child is entering an MCPS school for the first time or is entering Kindergarten, you will need to complete the MCPS Student Record Card.
MCPS Pre-Participation Form for Athletes – SR-8
MCPS Authorization to Administer Prescribed Medications
- On the cover sheet please specifically list the medication you are requesting this for this form.
MCPS Authorization to Administer Prescribed Medications (for children with multiple medications)
- If your child will need prescription medication or over-the-counter medication at school, you must complete one form for each medication. Please note this is a mandatory requirement per MCPS.
MCPS Epipen Authorization Epipen Shortage Notice- Read More >>
Montgomery County Asthma Action Plan & Medication Authorization Form
Archdiocese Health Forms
Archdiocese Health Inventory Form
Archdiocese Allergy Agreement and Action Plan
Archdiocese Medication Authorization Form
Miscellaneous Health Forms
Age of Consent Form/ Authorization to Release Medical Information
DC Universal Health Certificate Form
Georgetown Prep Health History Record 2017 School Year
Good Counsel Physical Exam Health Form
Green Acres OTC Medication Form
Montgomery Sports Association (MSA) Medication Authorization Form
American Lung Association Asthma Action Plan
BBYO Teen Medication Form
Is your school/camp form not available?
Email firstname.lastname@example.org a blank PDF copy and we will review the form you’ve submitted. If there is a high enough patient demand we will build an online version within 14 days for future automatic submission. We thank you for submitting blank copies to our office, and ask that you still submit your non-electronic forms using the cover sheet and form submission option below. Please note, we will not be building out private school forms that are replicas of Maryland State Forms.
Health forms not available on our website through automatic submission may be submitted by completing the cover sheet below and attaching your forms. Please ensure the parent section is completed prior to submitting your forms. Failure to complete the cover sheet and/or parent section will result in your forms being rejected.
Please note that all forms may take up to 7 business days to be completed. We receive the highest volume of health forms April-August, resulting in completion times that may take the full 7 days. Forms are completed as they are submitted. There is no fast-track or expedited process for late submissions.