Special Medical Considerations

Food Allergy Action Plan - To best care for your child's needs at school, please complete this Food Allergy Action Plan and then review the information with the school nurse.

General Allergy Action Plan - This General Allergy Action Plan is for student's with environmental allergies that may need an antihistamine (i.e., benadryl) or epinephrine (EpiPen) after contact with an allergen.  An example would be for allergies to bee stings.  Please complete this form and then review the information with the school nurse.

Medication Consent Form - For any allergy medications that may need to be given at school, a consent form for administration will need to be completed.

MT Authorization Form - This Montana state form allows a student to possess or self-administer asthma, severe allergy, or anaphylaxsis medication at school.  This would include medication such as an EpiPen.  This form must be signed by a provider.

Asthma Action Plan - To best care for your child's needs at school, please complete this Asthma Care Plan and then review the information with the school nurse.

Medication Consent Form - For any asthma medications that may need to be given at school, a consent form for administration will need to be completed.

MT Authorization Form - This Montana state form allows a student to possess or self-administer asthma, severe allergy, or anaphylaxsis medication at school.  This would include medication such as an inhaler.  This form must be signed by a provider.

Healthcare Provider Orders/Diabetes Medical Management Plan - This treatment plan is made in conjunction with your student's provider and is essential to properly care for your student.  Please choose one of the following options. 

• (PREFERRED FORM)  The American Diabetic Association (ADA) developed a Diabetes Medical Management Plan (DMMP) to specifiy student care at school.  Parents/guardians fill out the first 5 sections, and the provider fills out the remaining 4 sections.  This is a type-entry form for your convenience or may be printed and filled out.

• Form for a student using an INSULIN PUMP  and the accompanying ALGORITHM for blood glucose results from MT DPHHS.

• Form for a student using INSULIN INECTIONS  and the  accompanying ALGORITHM for blood glucose results from MT DPHHS.

Questionnaire for Parent - Completing this questionnaire is key to providing appropriate care and support for your student. 

Seizure Action Plan - Please complete this Seizure Care Plan and then review the information with the school nurse.

Medication Consent Form - For any seizure medications that may need to be given at school, a consent form for administration will need to be completed.