Printable Forms

If your child has asthma, severe/life threatening allergies, diabetes, seizures, other chronic illness, or physical or psychological condition, please talk with the nurse.

Students with chronic conditions of asthma, severe allergies requiring an EpiPen, seizures, and/or diabetes, are required by the school district to have an emergency action plan completed and signed by the student's doctor. These plans need to be on file with the nurse in the Health Room. The link below will take you to the LPS District Health Services Page where you will find the Severe Allergy Policy and Procedures Handbook as well as the emergency action plans for severe allergies, asthma, diabetes, and seizure disorders. Click HERE: https://www.lps53.org/Page/1981. Or you can click on the "Health Services/Health Forms" title above to be directed to the forms.

**Please note that these forms can now be used for consecutive years as long as there are no changes in the medications, dosages, or plan for use as ordered by your student's physician. Parental authorization for continued use of the plan on file and a new medication authorization form will be required to be on file for each new school year. Please check with the building nurse to review the current plan on file to make sure it is still up to date.