Asthma, Allergy, Students with Health Needs, and Medications Resources and Forms

Forms

Dietary Accommodation Form English

Dietary Accommodation Form Spanish

Sample Asthma Action Plan

Sample Allergy Action Plan

Medication Consent Form English

Medication Consent Form Spanish

Self Administration Medication Consent Form English

Self Administration Medication Consent Form Spanish

Needed forms and school supplies for health concerns:

• Severe Allergies:

EPI Pen and/or Benadryl and Medication Consent Forms

Allergy Action Plan from Physician

Dietary Accommodation form if food related

Individualized Health Plan    

• Asthma:

Inhaler and Medication Consent Form

Asthma Action Plan from Physician

Individualized Health Plan

• Chronic Conditions

Action Plan from Physician

Individualized Health Plan

Classroom Healthcare Plan

• Diabetes

Medication Consent Form for Insulin

Medication Consent Form for Glucagon

Physician's Individualized Plan of Care for current school year

Emergency Supplies at school: See Attached Checklist