Homebound Instruction Form - Greenville County Schools

ADVERTISEMENT

Instructions for
Completing the Medical Homebound Instruction Form
Section I – Student Information
SCHOOL PERSONNEL
School personnel should complete this section of the form when it is requested by the parent, legal guardian or
surrogate. The question regarding disability refers to the EFA pupil classification for Special Education
students.
Section II – Medical Information
PHYSICIAN
A licensed physician must fully and legibly complete this section. Partially completed sections cannot be
accepted. A diagnosis, prognosis, treatment plan and educational impact must be addressed. Dates are to be
determined by the physician and based on the treatment plan prescribed. Absences of longer than six weeks
duration may require additional information to be provided at that time. If a student is able to come back to
school prior to the projected return date, a medical release will need to be provided to school personnel. If the
student is unable to return by the projected return date, a new homebound form must be completed and the
prognosis and treatment plan updated.
Section III – Release
PARENT OR GUARDIAN
The parent, legal guardian, or surrogate must date and sign authorizing the release of medical, educational, or
mental health information to school officials. If the student is eighteen years old or above, then he or she must
sign the form. Failure to grant permission will delay the approval process and could possibly result in a denial.
Section IV – Authorization
HOMEBOUND COORDINATOR
This section should be blank when submitted.

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Medical
Go
Page of 3