The San Francisco Medical Society is partnering with leaders in the Department of Public Health's Maternal and Child Health branch and local pediatricians to support the Pediatric Advisory Council.
Resources Developed by the Pediatric Advisory Council
SFUSD Forms for Clinicians
Please click on the individual links below to download the appropriate forms. To view the complete list of forms provided by SFUSD's Student, Family, and Community Support Department, please click here.
Some forms are also available in other languages. Please note the Chinese and Spanish versions have translations of the parent instructions and parent consent section. The health care provider section is the same.
SFUSD School Health Form (Kindergarten Entrance Form)
SFUSD Preparticipation Physical Exam (Sports Physical Form)
Medication Form (for medication to be given at school): English 中文 (Chinese) español (Spanish)
Asthma Inhaler Medication Form (for asthma medication to be given at school): English 中文 (Chinese) español (Spanish)
Generic Emergency Care Form: English 中文 (Chinese) español (Spanish)
Physician's Report - Childcare Centers: Child's Preadmission Health Evaluation (daycare/preschool entrance form)
CHDP Development Referral List
Golden Gate Regional Center (GGRC). GGRC serves residents of Marin, San Francisco, and San Mateo counties who fall into any of the following three categories: individual with a developmental disability, infant or toddler (up to 36 months of age) who has a developmental delay, infant or toddler (up to 36 months of age) for whom there are established risk conditions that could lead to a developmental delay.
SFGH Multi-Disciplinary Assessment Clinic (MDAC). Based at San Francisco General Hospital, MDAC provides developmental and behavioral evaluations for children ages 0-5 living in San Francisco, with funding provided by First 5 California. Children between ages 6-22 may also be seen at MDAC provided they live in San Francisco, have MediCal, and are pre-approved by their insurance providers. Click here to download the MDAC referral form.
SFUSD Preschool Special Education Services. Children ages 3-5 may be referred to San Francisco Unified School District Preschool Intake to determine their eligibility for special education services.
SFUSD Authorization for Release of Confidential Information. Forms available in English, Chinese, and Spanish. Completed from must be sent to school or if 3-5 yrs old, to SFUSD Special Ed Special Education Services, 750 25th Avenue, San Francisco, CA 94121, T (415) 379-7693, F (415)750-8690.Click on the appropriate link for your language of preference:
English 中文 (Chinese) español (Spanish)
SFUSD Nurse of the Day Program strives to provide current health information and guidance regarding students’ health issues by working with students, San Francisco Unified School District (SFUSD) employees, caregivers, and community-based organizations. To reach Nurse of the Day, please call (415) 242-2615.
Reporting (CPS, Communicable Diseases)
- Communicable disease reporting guidelines for clinicians. Includes links to list of legally reportable diseases and conditions, reporting forms, and publications from the San Francisco Department of Public Health Communicable Disease Control and Prevention Unit.
- Confidential Morbidity Report (CMR). Downloadable form to report STDs, TB, and other communicable diseases like pertussis and varicella.
- CPS Child Abuse Report. Downloadable form for clinicians to report child abuse. Additionally, contact the Family and Children's Services Hotline at (800) 856-5553 to make a confidential report of suspected child abuse or neglect.
Mission, Goals, and Objectives
To improve children’s health by increasing coordination and collaboration among children’s healthcare systems in San Francisco.
- Improve quality of pediatric clinical care by sharing best-practices, efficiencies, resources.
- Increase appropriate access and utilization of healthcare services primary care, family planning, dental, and behavioral health services.
- Improved understanding of the strengths and gaps in children’s health care.
- Address social determinants of health in which multiple healthcare systems can significantly change policies and systems.
- Share relevant information amongst the Pediatric Advisory Council members, representing the different health care systems in San Francisco
- Provide advice to the Maternal, Child & Adolescent Health Section of the San Francisco Department of Public Health on issues related to children’s healthcare.
- Receive public health updates from various sections of the San Francisco Department of Public Health
- Build infrastructure for coordination and collaboration between health systems to improve children’s health.
- Develop two-way communication between primary care providers of major institutions in San Francisco.
If you have any issues that you would like the Pediatric Advisory Group to consider, please send us a comment.