Pass to Nurse's Office

Pass to the nurse's office. Four passes per sheet. Includes student name, date, time leaving class, checklist of reasons for visiting the nurse, checklist for nurse to mark "actions taken" (called home/provided meds/checked temp), place for nurse to write the time student left, and nurse's signature.
I worked at one middle school where passes like this were provided for teachers, but have since moved and had no pre-printed passes available, so I just made one based on what I remembered! Thanks & leave feedback!