Medical Forms


For Students with Asthma or Life-Threatening Allergies:

Forms to be completed and signed before student can enter school annually:

  1. IHPs

  2. Action Plan (signed & completed by parent/guardian and child's physician)

  3. Emergency Epinephrine Administration by a Trained Delegate Form

    1. Epinephrine Self-Administration Form (ONLY for students allowed to self-administer epinephrine as designated by their physician)

  4. Medication Submission Form

MEDICATIONS MUST BE GIVEN DIRECTLY TO THE NURSE BY A PARENT/GUARDIAN - THEY CANNOT BE SENT IN WITH THE STUDENT.

ALL FORMS AND EMERGENCY MEDICATIONS MUST BE COMPLETED IN ENTIRETY AND HANDED IN PRIOR TO THE STUDENT ATTENDING IN-PERSON INSTRUCTION.