WHICH FORM DOES MY CHILD NEED?

 

INSTRUCTIONS:  If your child has asthma and uses an inhaler or nebulizer then print the Asthma Medication Form.  If your child has a life threatening allergy then print the Epi Pen Administration Form.  If your child has a chronic life threatening medical condition and is capable of self administration of their medications (insulin, digestive enzymes, benadryl for anaphylaxis, etc.) then print Self Administration Form.  For any other medications that may need to be given during school hours then use the Medication Adminstration Form.

 **All of these forms require signatures by the Health Care Provider as well as the parent/guardian.** If you have any questions, please call your child's school nurse.  Thank you.

 

Food Allergy Action Plan

Epi Pen Form for Preschool through 4th Grade

Physical Form

Asthma Medication Form

Self Administration Of Medication Form

Medical Administration Form

   High School Forms

  Epi Pen Form for 5th through 8th Grades Only

Created by Barbara Beaver 2/5/04