Health Forms

Medication Administration Request Form

• Medications that you want kept in the Nurse's office and administered at a specific time or as needed 

• The form must be signed by both you and the child's medical provider 

• Examples: ADHD medication, over-the-counter medication (including cough drops), rescue inhaler, etc. 

**Please be sure the provider gives a REASON for meds that are taken "as needed" (i.e. Albuterol Inhaler - 2 puffs every 4 hours AS NEEDED FOR wheezing, cough, or shortness of breath)

Self-Administration of Prescribed Asthma/Anaphylaxis Medicine 

• Form is used when a student is able to carry their own inhaler and/or anaphylaxis medication while at school 

• Student's Medical Provider must sign this form noting that the student possess the skill(s) and competency level to independently administer medication 

Specialized Health Care Procedure Form 

Examples for when to use this form:

• EpiPens or Auvi-Q's 

• Catheterization

• G-tube feedings

• Tracheostomy care 

**Nebulizer treatments are currently NOT permitted on any FWISD campus - if a student needs a Nebulizer treatment during the school day a parent/guardian can sign the student out, take them home to administer treatment and sign the student back in to continue their school day**

Nutrition Services Dietary/Allergy Request Form 

• Needs to be filled out and signed by Medical Provider when a student has food allergies (must be completed each school year - regardless if allergies/dietary restrictions are the same as previous school year)

• Form is sent to campus Cafeteria Manager and FWISD Dietician - allows for a "flag" to be entered on student's account 

  • If a student goes through the lunch line and tries to buy an item that contains ingredients in which the student cannot have the employee would get a notification and help the student choose a different option