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Medication Request Form
This form is required for each medication to be taken at school.
NEBULIZER TREATMENTS WILL NOT BE ADMINISTERED IN THE SCHOOL SETTING WHILE COVID-19 RESTRICTIONS ARE IN PLACE.
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Severe Allergy Management Plan
Parent & Physician form for management of a student's severe allergies. Includes section for permission to self-carry epinephrine.
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Asthma Action Plan
Physician form regarding management of asthma symptoms.
NEBULIZER TREATMENTS WILL NOT BE ADMINISTERED IN THE SCHOOL SETTING WHILE COVID-19 RESTRICTIONS ARE IN PLACE.
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Asthma Inhaler Self-Carry Form
Parent & Physician permission form for a student to self-carry an asthma inhaler at school.
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Seizure Management Plan
Parent & Physician form for management and treatment of a student with seizures.
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Gastrostomy & Tube Feeding Management Plan
Parent & Physician form for management of gastrostomy and nasogastric tubes/feedings in the school setting.
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Tracheostomy Management Plan
Parent & Physician form for care and management of a student with a tracheostomy.
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Supplemental Oxygen
Parent & Physician form for management of a student requiring supplemental oxygen therapy in the school setting.
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Adrenal Insufficiency Treatment Plan
Parent & Physician form for management of a student with adrenal insufficiency.
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Specialized Health Care Request
Parent & Physician form for specialized health care not specified on other forms.
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Diabetes Management & Treatment Plan (Multiple Daily Injections)
Parent & Physician form for management & treatment of diabetes of student with diabetes receiving multiple daily injections of insulin.
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Diabetes Management & Treatment Plan (Insulin Pump)
Parent & Physician form for management of diabetes for a student with an insulin pump.
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Additional Required Diabetes Forms
Includes Unlicensed Diabetes Care Assistant form and Parent/Student Responsibilities form.
