FISD Health Services

HEALTH FORMS (see color-coded chart below)

Allergies:  Severe FOOD

Medication:  Parent/Guardian Request Form

• requires parent signature

• doctor's signature required:

  •  for over-the-counter medications other than acetaminophen (Tylenol), Ibuprofen (Advil/Motrin), Tums, Diphenhydramine  (Benadryl)

  • after ten doses of the above-referenced medications have been administered in one school year

• each form holds two medications

Emergency Care Plan

• requires parent's and physician's signatures

• can use physician's own form

Self-Administration of Prescription Asthma or Anaphylaxis Medication by Student

• requires parent's and physician's signatures

Special Diet and Allergy Accommodation

• requires parent's and physician's signatures

• email completed form to specialdiets@friscoisd.org

• NOTE: this form does NOT need to be renewed each year unless there have been changes

Food Allergy Information and Consent

• requires parent's signature

Allergies:  Severe NON-food

Medication:  Parent/Guardian Request Form

• • requires parent signature

Emergency Care Plan

• • requires parent's and physician's signatures

  • can use physician's own form

Self-Administration of Prescription Asthma or Anaphylaxis Medication by Student

Asthma:

Medication:  Parent/Guardian Request Form

• requires parent signature

Emergency Care Plan

• • requires parent's and physician's signatures

  • can use physician's own form

Self-Administration of Prescription Asthma or Anaphylaxis Medication by Student

Diabetes:

Medication:  Parent/Guardian Request Form

• requires parent signature

Diabetes Medical Management Plan

• requires parent's and physician's signatures

• can use physician's own form

Recommended Diabetes Supplies

Seizures:

Medication:  Parent/Guardian Request Form

• requires parent signature

Seizure Action Plan

• • requires parent's and physician's signatures

  • can use physician's own form