Medical Forms

New and returning students with life threatening medical conditions are required to have the appropriate paperwork completed and delivered to the main office.

(students are authorized to administer their own medication)

(staff is required to administer or supervise the administration of oral mediation)

Medical Condition

Form 802




Form 616

 

Must be signed by Allergist or Physician

Form 405

 

Must be signed by Allergist or Physician

Form 286

 

Must be signed by Allergist or Physician

Form 285

 

Must be signed by Allergist or Physician

Form 902




Anaphylaxis

 

✔️

✔️

✔️ (If providing Benadryl)

   

Asthma

✔️

   

✔️

✔️

(If the student has permission to carry puffer in backpack and self-administer)

 

Diabetes

✔️

       

✔️

Epilepsy

✔️

   

✔️ (If providing medication)

   

Other serious medical condition

✔️

   

✔️ (If providing medication)

   

Parents are strongly encouraged to provide a Medic Alert bracelet for students with serious medical conditions. This service is free of charge for school-aged children ages 4 to 14.