Form Determination Chart

Please consult the chart below to determine which Health Services forms are required based on your student's health concern.  Simply click and print the form titles that you require.

Please note that ALL medications require written doctor's authorization.

Student's Health Concert

Asthma or Allergy Action Plan

Food Allergy Action Plan

Diabetic Care Plan

Identified Health Concern

Dispensing Medication

Seizure Action Plan

Treatment or Procedure Authorization

Allergies:
Non-Food

X

 

 

 

X
(if applicable)

 

 

Allergies:
Food

 

X

 

 

X
(if applicable)

 

 

Asthma

X

 

 

 

X
(if applicable)

 

 

Health Concern: Medicated During School Hours

 

 

 

X

X
REQUIRED

 

 

Health Concern: Not Medicated During School Hours

 

 

 

X

 

 

 

Diabetes

 

 

X

 

X
(or equivalent)

 

 

Seizure Disorder

 

 

 

 

X
(if applicable)

X

 

Medical Treatment or Procedure required during school hours

 

 

 

X

X
(if applicable)

 

X


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