Special Procedure Forms / SPED 

Immunization Affidavit

Please bring the original Affidavit for Immunizations to the school; it must be on file in the health office. 

Parents are responsible for keeping this up to date; a new one will be required before it expires in 2 years. 

Toileting

Our Sped team in the classrooms are able to assist with toileting; no special orders are needed in the Sped environment. Parents must provide any necessary supplies such as wipes, extra change(s) of clothes, etc. 

Vision and/or Hearing Screen

The Texas Department of State Health Services Vision, Hearing and Spinal Screening requirements mandate that all children must be screened or have a professional examination for potential problems. Please provide a copy of the most recent screening results from her physician; these are usually done at well-child checks. 

Forms for Health Services

Please see below with links to download, along with explanations. 

If you prefer a hard copy, I can provide those to you as well if you are able to pick them up, let me know.  These forms must be filled in with specific details and signed by both parent and physician. 

Each school year, we will need updated physicians' orders and parent authorizations. 

Tube Feedings

Physician's Authorization for Special HealthCare (requires attachment on EM, no link available)

This form will list specific info, such as allowing the student to have water orally as well as listing reasons for needing GT feedings, aspiration precautions, equipment types to be used in addition to covering procedures/emergency plan for potential complications like tube dislodgement or clogging.  

*On line #5, be sure to list 'Aide, Paraprofessional, Teacher, School Nurse, Substitute School Nurse'.  We provide training to our staff to assist with these daily needs, thus allowing for greater flexibility, inclusion, and efficient use of resources.

Gastrostomy Tube Feeding Authorization Form (clickable link)

This form lists feeding details, instructions, supplies, safety protocols, and authorization. Be specific. 

Parents are required to furnish all equipment, supplies, medication, formulas, or other necessary items for the administration of the procedure and to provide replacement and maintenance as necessary. An extra set is recommended. 

A dressing should be placed between the tube and skin; these need to be provided as well.  

Parents are required to notify the school nurse immediately if there is any change in the student’s status or provider orders; a copy will be required. 

Please note, the school nurse or other staff will not reinsert a dislodged G Tube. Tubes can cause harm through trauma on insertion, as well as fatalities due to feed being inserted through a misplaced tube. If her G Tube becomes dislodged, we will simply cover the area with a dressing and notify you. 

Medication: Parent/Guardian Request Form (clickable link)

This form will accompany the GT order set, listing the formula type/details.  This requires a parent's signature. 

Food Allergy

If your child has a medical diagnosis of a Life-Threatening Allergy, Asthma, or Seizures, we prefer to have an Action plan & Emergency Medication to be kept in the clinic. A physician & the parent must fill this paperwork out so that we can better treat your child. This cannot be accepted without the signature of the physician. The Action Plans must be updated yearly.  Be sure to share a copy of your student’s care plan with pertinent staff such as the teacher, coach, trainer, program director, bus driver, etc. 

        Emergency Care Plan (clickable link)

• requires parents' and the physician's signature

• can use the physician's own form

• Medication: Parent/Guardian Request Form  (clickable link) - This form is to accompany the Allergy Plan, listing emergency medication as indicated on the plan. This requires a parent's signature. 

Special Diet and Allergy Accommodation (clickable link) - A physician & the parent must complete this form so that food services know that your child cannot have certain foods or any food at all if on specialized feeding orders from a physician.  The cafeteria does not have access to your child’s food allergy or special feeding plan information – the only way they will be aware of it is if they have this form on file. Unless there is a change in a food allergy/feeding status, the form only needs to be completed & submitted once while enrolled with FISD. For more information, please refer to the “Students with Food Allergy, Intolerance or Medical Disability” section.

• Email completed form to specialdiets@friscoisd.org

Food Allergy Information and Consent

• requires a parent's signature

• Note: Secondary schools do not have nut-aware/nut-free classrooms or lunch tables.
  
  

After all paperwork is properly filled out, it can be brought to the school nurse along with any indicated medication(s)/supplies. 

Medications

• Prescriptions must have a valid label

• All medications must be in the original container

• Expired items will not be accepted or administered, no exceptions

• Any medication that is not picked up by the end of the school year will be properly disposed of by Frisco ISD. 

• Expired medication will be properly disposed of by Frisco ISD. 

• Students are not allowed to carry any medication in their backpacks, lunch boxes, or pockets (including vitamins/supplements). 

LTHS School Nurse Website for helpful information, links, guidelines, and resources: https://sites.google.com/friscoisd.org/lths-school-nurses-corner/home

Frisco ISD Health Services Website: https://www.friscoisd.org/departments/health-services/home

Frisco ISD Special Education Website: https://www.friscoisd.org/departments/special-education/home