HEALTH CARE PLANS
*We are currently in the process of updating our paperwork. If you are unable to find the forms that you need, please contact your school health aide. *
Health care plan forms must be submitted every twelve months. Please print your paperwork and bring it to your school Health Aide. All health care plans require a parent and healthcare provider signature. Each health concern below will be followed by links to any pertinent forms.
- The schools cannot accept any medication unless it is delivered by the student's guardian with the appropriate paperwork and labels. No medication may be administered without a physician signature. Your school health aide could assist you in facilitating this. Each medication must have a pharmacy label. If it is an over the counter medication, any local pharmacy should provide you with a label for school.
- Every student with a medical concern must have a bus form submitted regardless of their daily methods of transportation to school. These forms are necessary for the student to attend field trips.
FORMS BY CONDITION
Allergy Health Care Plan Forms
Please submit “Allergy & Anaphylaxis Emergency Action Plan.” If your student requires lunchroom accommodations submit the “Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions.” These forms must be completed annually with parent and healthcare provider signature. Every student with an allergy requires an "Allergy Bus Form." Every student receiving a medication in school must have a "Daily Medication Log" filled out and signed upon delivery of the meds to the health office.
Asthma Health Care Plan Forms
ADD/ADHD Health Care Plan FormsCurrently, the only paperwork required at the health office for ADD/ADHD is the "Authorization for Student Medication" signed by a physician. The medications will need to be checked in by parents and the health aide before it could be given at school. The student's IEP/504 should cover any academic interventions. If there are any other concerns, a Generic IHP could be submitted by the parent.
Celiac/Gluten Free Forms
In order to qualify fo special meal requests, a physician must sign the following form. This is the only paperwork required for Celiac/Gluten free unless this condition affects any other aspect of their school day.
Concussions/TBI Health Care Plan Forms
Cystic Fibrosis Health Care Plan Forms
Diabetes Health Care Plan Forms
The Diabetes Medication Management Order must be signed by a physician for ever student that requires medication at school.
If CGM is indicated, this form is required:
*The Diabetes Emergency Action Plan and Diabetes Individual Health Care Plan are intended for the guardians and nurses to make a plan specific to each student. These do not require a physician signature.*
*Every student with diabetes must have a bus form filled out for field trips*
G-Tube Feeding Order and Forms
Lactose Intolerance Health Care Plan Forms
In order to qualify fo special meal requests, a physician must sign the "Medical Statement to Request Special Meals, Accommodations, and Milk Substitutes." This is the only paperwork required for lactose intolerance unless this condition affects any other aspect of their school day. It would be at that point that a "Lactose Intolerance HCP" would be necessary.
Seizure Health Care Plan Forms
The "seizure medication management Order" is only required if the student needs to take seizure medication at school. We are only authorized to give this medication at school if it has both been previously given and been successful.
*If no medication is required, please fill out an Individualized Health Care Plan. Please ask your health aide for that form.*
Generic Health Care Plan
Medical Release Form
Medication Administration Authorization Forms