Health Forms

    Based on the answers you provided in the Health History form, please complete all applicable forms related to your child’s medical condition.
    Form 2a: Asthma Action Plan

    This form requires a physician’s signature and will need to be printed, completed, and returned to the school.

    Form 2b: Authorization for Self-Administration of Asthma Medication by Minor Child

    This form requires a parent and physician’s signature and will need to be printed, completed, and returned to the school.

    Form 3a: Food Allergy and Anaphylaxis Emergency Care Plan

    This form requires a parent and physician’s signature and will need to be printed, completed, and returned to the school.

    Form 3b: Authorization for Self-Administration of Epi-Pen by Minor Children at School

    This form requires a parent and physician’s signature and will need to be printed, completed, and returned to the school.

    Form 4: School Management of Diabetes Mellitus

    This form requires a parent and physician’s signature and will need to be printed, completed, and returned to the school.

    Form 5a: Seizure Action Plan

    This form requires a parent and physician’s signature and will need to be printed, completed, and returned to the school.

    Form 5b: Parent Notification of Protocol for Administration of Diastase

    This form requires a parent’s signature and will need to be printed, completed, and returned to the school.

    Form 6a: Medical Examination Report

    This form requires a physician’s signature and will need to be printed, completed, and returned to the school.

    Form 6b: Health Care Management Plan

    This form requires a physician’s signature and will need to be printed, completed, and returned to the school.

    Form 6c: Student Medical Emergency Plan

    This form requires a physician’s signature and will need to be printed, completed, and returned to the school.

    Form 6d: Medical Statement and Diet Prescription for Meals at School

    This form requires a parent and physician’s signature and will need to be printed, completed, and returned to the school.

    Form 7: Administration of Medication/Medical Procedure

    This form requires a parent and physician’s signature and will need to be printed, completed, and returned to the school.