Forms

These forms will allow the health services team to provide care for your student while 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 (Spanish)

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

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

If your student is a diabetic, please use one of these forms or your physician printed school order form: 
Diabetic Orders Without Pump - English (Spanish)
Diabetic Orders with Pump - English (Spanish)

If your student requires enteral feeding, please use this form:
Enteral Tube Feeding Form

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

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