Medical Excuse Form Yes No Yes No - Bullitt County Public Schools - bullittschools 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name and school name in the designated fields at the top of the form.
3. Authorize the health care provider to release information by signing in the provided space for the parent or guardian.
4. Fill in the date and time of the appointment, along with 'Time In' and 'Time Out' details.
5. Select one reason for the appointment from the options provided by checking the appropriate box.
6. Indicate whether it was medically necessary for the student to be absent all day by selecting 'Yes' or 'No'.
7. If applicable, answer whether absence was due to office location issues.
8. Complete any additional requirements if absence exceeds five consecutive days, as noted on the form.
9. Finally, provide the health care provider's name, address, and signature before submitting.

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