Clinic Pass - Broward County Public Schools Coordinated Student 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date at the top of the form. This helps track when the clinic visit occurred.
3. Fill in the student's name, including last and first names, ensuring accuracy for identification purposes.
4. Indicate the teacher's name and select the student's gender (M/F) as well as their date of birth (DOB).
5. Specify the grade level of the student to provide context for their educational stage.
6. Input contact phone numbers for quick communication regarding the student’s health status.
7. Detail the reason for referral, providing a clear description of why the student is visiting the clinic.
8. Complete sections related to clinic use, including arrival time, nature of complaint, actions taken, and disposition of student.
9. Ensure all necessary signatures and notifications are completed before finalizing and saving your document.

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