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Forms

These forms will allow the health services team to provide care for your student while he or she is at school. Please feel free to ask your campus clinic staff if you have any questions. 

If your student requires medication at school, please use one of these forms:
Request to Administer Medication-English
Request to Administer Medication-Spanish

For students with anaphylaxis to food, insects, or other substances, please use one of these forms:
Food & Allergy Anaphylaxis Plan-English
Food & Allergy Anaphylaxis Plan-Spanish

For students with respiratory issues requiring an inhaler or nebulizer, please use this form: 
Respiratory Action Plan English/Spanish

For students with a seizure disorder, please use this emergency plan:
Seizure Care Plan English/Spanish

If your child requires modification of school meals, please use one of these forms:
LISD Special Diet Form-English
LISD Special Diet Form-Spanish

If your student is a diabetic, please use one of these forms or your physician printed forms for school orders:
Diabetic Orders with Pump-English
Diabetic Orders with a Pump-Spanish
Diabetic Orders without a Pump-English
Diabetic Orders without a Pump-Spanish

IF your students requires enteral feeding, please use this form:
Enteral Tube Feeding Authorization Form

If your student requires a special procedure, such as catheterization or tracheal suctioning, please use this form:
Special Procedure Form-English/Spanish

For our older students, who the parents, the physician and the health service staff, deem able to administer their own emergency medication, please use one of these forms:
Self-Carry Medications-English
Self-Carry Medication-Spanish

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