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CAMPUS

Medication Forms

 

Forms

ACTION PLANS

Action plans are to be completed for Asthma, Food Allergies, Seizures, or Anapylaxis (other than food allergy). These forms should be completed yearly by the childs physician prior to the start of school and turned in to the campus nurse. 

Asthma Action Plan 

Food Allergy Action Plan

Meal Modification Plan-Any student with food allergy has to have this form completed by physician every year to keep on file in cafeteria. 

Seizure Action Plan

Anaphylaxis Action Plan

Diabetic Management -For students with diabetes and does not have a diabetic medical management plan completed at physicians office, this form shall be completed by their physician. 

Catheter Order Form-  For students that require intermittent catheterization this form needs to be completed by the physician. 

 

Medication Administration Forms

If your child is to take medications at school, you must fill out the required paperwork. (This includes asthma inhalers.) Also if your child is given medication throughout the year (antibiotics, eardrops, etc.) to be given 3 times a day, you should give it before school, right after school, and at bedtime. This eliminates the possibility of the medicine being left at school and not accessible for other doses. Please click the links below for required medication paperwork. 

Medication Form-completed on all medications to me given at school.

Self Administration Consent Form-for students grades 5-12 that will carry and self administer asthma inhalers, epipens, or emergency glucagon.

Physician Order Form-To be completed by the childs physician yearly for ANY medication to be given at school. 

Epinephrine Administration Consent Form-Consent to give epinephrine in an emergency situation to a child with documented severe allergic reaction.

Glucagon & Insulin Administration Consent-Consent for nurse and TDP to administer insulin and glucagon as ordered by physician. 

Glucagon Carry Consent-For students grades 5-12 that will carry own emergency glucagon to be given in an emergency situation by nurse or TDP. 

Admission Forms

Authorization to Treat a Minor- This form MUST be completed on all students. If this form is not completed the student will not be allowed to attend ANY field trips. 

Kindergarten Physical Forms- This form MUST be completed on all new kindergarten students.

Athletic Physical Forms

Athletic Physicals