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.
Request to Administer Medication
If your student requires medication at school, please use one of these forms:
Request to Administer Medication: English | Spanish
Food Allergy & Anaphylaxis Plan
For students with anaphylaxis to food, insects, or other substances, please use one of these forms:
Food Allergy & Anaphylaxis Plan: English | Spanish
Respiratory Action Plan
For students with respiratory issues requiring an inhaler or nebulizer, please use this form:
Respiratory Action Plan: English | Spanish
Seizure Care Plan
For students with a seizure disorder, please use this form:
Seizure Care Plan: English | Spanish
Self-Carry Medications
For our older students, who the parents, the physician, and the health service staff deem able to administer their own emergency medication, please use this form:
Self-Carry Medications: English | Spanish
Special Diet
If your child requires modification of school meals, please use one of these forms:
Special Diet Form: English | Spanish
Diabetic Orders
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
Enteral Tube Feeding
If your student requires enteral feeding, please use this form:
Enteral Tube Feeding
Special Procedures
If your student requires a special procedure, such as urinary catheterization or tracheal suctioning, please use this form:
Special Procedures: English | Spanish