{"id":168,"date":"2021-08-10T14:04:13","date_gmt":"2021-08-10T18:04:13","guid":{"rendered":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/?page_id=168"},"modified":"2025-08-20T08:20:17","modified_gmt":"2025-08-20T12:20:17","slug":"medical-forms","status":"publish","type":"page","link":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/","title":{"rendered":"Medical Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"168\" class=\"elementor elementor-168\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-34efff16 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"34efff16\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-78a4e424\" data-id=\"78a4e424\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-044c86b elementor-widget elementor-widget-text-editor\" data-id=\"044c86b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"background: white\"><span style=\"color: #000000\"><span style=\"font-size: 12pt;font-family: 'Century Gothic', sans-serif\">Please contact our school nurse, Mary Shymkiv-Bakker, with any concerns or questions.<\/span><\/span><\/p><p>Office 904.547.4292\u00a0<\/p><p>Fax 904.547.4265<\/p><p><a href=\"mailto:mary.a.shymkiv-bakker@stjohns.k12.fl.us\">Email Nurse Shymkiv-Bakker<\/a><\/p><h5 style=\"background: white\">\u00a0<\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-38a85e8d elementor-widget elementor-widget-text-editor\" data-id=\"38a85e8d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li><a href=\"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-content\/uploads\/sites\/26\/2021\/08\/Medication-Authorization-form-.pdf\">Medication Authorization Form<\/a><\/li><li><a href=\"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-content\/uploads\/sites\/26\/2022\/08\/Self-Carry-Form.pdf\">Self Carry Form<\/a><\/li><li><a href=\"https:\/\/nam12.safelinks.protection.outlook.com\/?url=https%3A%2F%2Finside.stjohns.k12.fl.us%2Fhealth%2Ffiles%2F2023%2F05%2FAllergy-Medical-Managment-Plan-MMP.pdf&amp;data=05%7C02%7CCourtney.Mazerolle%40stjohns.k12.fl.us%7C8700814dbb414f0cb4b108dd83341c45%7Cb3b3d057fc124f3f92f472be6e844351%7C0%7C0%7C638810982007744157%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=xa7IQ07yYi6iNcrJPdMiTqaE1Xjz6YxFsVN5BWDmYq4%3D&amp;reserved=0\">Allergy Medical Management Plan<\/a><\/li><li><a href=\"https:\/\/nam12.safelinks.protection.outlook.com\/?url=https%3A%2F%2Finside.stjohns.k12.fl.us%2Fhealth%2Ffiles%2F2022%2F07%2FAsthma-Medical-Management-Plan-MMP.pdf&amp;data=05%7C02%7CCourtney.Mazerolle%40stjohns.k12.fl.us%7C8700814dbb414f0cb4b108dd83341c45%7Cb3b3d057fc124f3f92f472be6e844351%7C0%7C0%7C638810982007787425%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=3LPFCbWPNybN2eaKev6Ex2E8eh2D4PY1uuMTgJoW3Pc%3D&amp;reserved=0\">Asthma Medical Management Plan<\/a><\/li><li><a href=\"https:\/\/nam12.safelinks.protection.outlook.com\/?url=https%3A%2F%2Finside.stjohns.k12.fl.us%2Fhealth%2Ffiles%2F2022%2F07%2FBleeding-Disorders-Medical-Management-Plan-MMP.pdf&amp;data=05%7C02%7CCourtney.Mazerolle%40stjohns.k12.fl.us%7C8700814dbb414f0cb4b108dd83341c45%7Cb3b3d057fc124f3f92f472be6e844351%7C0%7C0%7C638810982007839819%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=VbaxFppcc1d9G5TimFZ5jmutewsAXlL2uVnlJyGJWWY%3D&amp;reserved=0\">Bleeding Disorders Medical Management Plan<\/a><\/li><li><a href=\"https:\/\/nam12.safelinks.protection.outlook.com\/?url=https%3A%2F%2Finside.stjohns.k12.fl.us%2Fhealth%2Ffiles%2F2022%2F07%2FCardiac-Medical-Management-Plan-MMP.pdf&amp;data=05%7C02%7CCourtney.Mazerolle%40stjohns.k12.fl.us%7C8700814dbb414f0cb4b108dd83341c45%7Cb3b3d057fc124f3f92f472be6e844351%7C0%7C0%7C638810982007816124%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=L7HAr%2Fl%2FcZeOBYhLW9W606FEnqSGEBheAyyfZEG5mx0%3D&amp;reserved=0\">Cardiac Medical Management Plan<\/a><\/li><li><a href=\"https:\/\/nam12.safelinks.protection.outlook.com\/?url=https%3A%2F%2Finside.stjohns.k12.fl.us%2Fhealth%2Ffiles%2F2022%2F07%2FCystic-Fibrosis-Medical-Management-Plan-MMP.pdf&amp;data=05%7C02%7CCourtney.Mazerolle%40stjohns.k12.fl.us%7C8700814dbb414f0cb4b108dd83341c45%7Cb3b3d057fc124f3f92f472be6e844351%7C0%7C0%7C638810982007857180%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=i2%2Fc1GtO8yfnM0bzUT5QknFRt5BRp4eSLr%2BddDLysuY%3D&amp;reserved=0\">Cystic Fibrosis Medical Management Plan<\/a><\/li><li><a href=\"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-content\/uploads\/sites\/26\/2022\/08\/MMP-Diabetes-2021-22.pdf\">Diabetes Medical Management Plan<\/a><\/li><li><a href=\"https:\/\/nam12.safelinks.protection.outlook.com\/?url=https%3A%2F%2Finside.stjohns.k12.fl.us%2Fhealth%2Ffiles%2F2022%2F07%2FSeizure-Medical-Management-Plan-MMP.pdf&amp;data=05%7C02%7CCourtney.Mazerolle%40stjohns.k12.fl.us%7C8700814dbb414f0cb4b108dd83341c45%7Cb3b3d057fc124f3f92f472be6e844351%7C0%7C0%7C638810982007874271%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=jrCrgLkQy1cXSM517yv0psk45c7ssptE%2FgieiPaR6bc%3D&amp;reserved=0\">Seizure Medical Management Plan<\/a><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Please contact our school nurse, Mary Shymkiv-Bakker, with any concerns or questions. Office 904.547.4292\u00a0 Fax 904.547.4265 Email Nurse Shymkiv-Bakker \u00a0 Medication Authorization Form Self Carry Form Allergy Medical Management Plan Asthma Medical Management Plan Bleeding Disorders Medical Management Plan Cardiac Medical Management Plan Cystic Fibrosis Medical Management Plan Diabetes Medical Management Plan Seizure Medical Management [&hellip;]<\/p>\n","protected":false},"author":429,"featured_media":0,"parent":0,"menu_order":-1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"default","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-168","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-json\/wp\/v2\/pages\/168","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-json\/wp\/v2\/users\/429"}],"replies":[{"embeddable":true,"href":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-json\/wp\/v2\/comments?post=168"}],"version-history":[{"count":5,"href":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-json\/wp\/v2\/pages\/168\/revisions"}],"predecessor-version":[{"id":286,"href":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-json\/wp\/v2\/pages\/168\/revisions\/286"}],"wp:attachment":[{"href":"https:\/\/www-tchs.stjohns.k12.fl.us\/clinic\/wp-json\/wp\/v2\/media?parent=168"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}