Skip To Main Content

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-Administration Form (E)

Asthma Action Plan 2023 (Spanish) -Asthma Emergency Action Plan & Medication Authorization/Self-Administration Form (S)

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)

Vision Certificate for School Entry

Sample Vision Opt-Out Form