Medical Forms for Parents
Please use this forms if your child has a medical plan.
Allergy & Anaphylaxis:
Allergy and Anaphylaxis Emergency Action Plan 2023 (English) - Allergy/Anaphylaxis Emergency Action Plan (EAP)/Medication Authorization & Self Administration Form
Allergy and Anaphylaxis Emergency Action Plan 2023 (Spanish) -Allergy/Anaphylaxis Emergency Action Plan (EAP)/Medication Authorization & Self Administration Form
Allergy and Anaphylaxis Detailed IHP 2023 - Allergy/Anaphylaxis Individualized Healthcare Plan DETAILED
Asthma:
Asthma Action Plan 2023 (English) -Asthma Emergency Action Plan & Medication Authorization/Self-
Asthma Action Plan 2023 (Spanish) -Asthma Emergency Action Plan & Medication Authorization/Self-
Asthma Detailed IHP 2023 - Asthma Individualized Healthcare Plan DETAILED
Diabetes:
Seizure:
Seizure Action Plan 2023 (English) - Seizure Individualized Healthcare plan/Emergency Action Plan (E)
Seizure Action Plan 2023 (Spanish) - Seizure Individualized Healthcare plan/Emergency Action Plan (S)
Seizure Medication Management Order (SMMO) 2023 (English) - Seizure Rescue Medication Authorization (E)
Seizure Medication Management Order (SMMO) 2023 (Spanish) - Seizure Rescue Medication Authorization (S)
Detailed Seizure IHP 2023 -Seizure Individualized Healthcare Plan DETAILED
Head Injury:
Head Injury Flowchart 2021 -Flow chart for Parents & Teachers (This Flowchart would be great for Parents or Teachers to look over.)
These Next 4 forms would be more for secretaries to monitor a head injury and the also the form to send to a parent if an injury occurs.
Head Injury Checklist 2021 (English)
Head Injury Checklist 2021 (Spanish)
Parent Notification 2021 (English)
Parent Notification 2021 (Spanish)
Other Medication Order Forms:
Medication Authorization 2023 (English) -Medication Authorization form for PARENT & PHYSICIAN
Medication Authorization 2023 (Spanish) -
Medical Diagnosis Confirmation Template 2023
Vision Screening:
Vision Symptoms Questionnaire 2022 (English)
Vision Symptoms Questionnaire 2022 (Spanish)
Vision Referral to Eye Care Professional 2022 (English)
Vision Referral to Eye Care Professional 2022 (Spanish)