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Medication Forms

Form be completed by your doctor for any medications given at school including over the counter medications. 

Medication Administration Form 


Forms required for students with the following conditions: 

 1. Asthma

If your child requires an inhaler at school for prophylaxis before exercise or for treatment of asthma symptoms please bring the inhaler to the school office along with the Asthma Action Plan.  This form must be signed by you and your child's doctor and renewed every year. Your child may carry the inhaler with him/her if they are able to safely self-administer the medication and approved by their physician.  The Asthma Action Plan is still required when your child carries an inhaler.

Asthma Action Plan (Required for all students with asthma)

2. Severe Allergy with Epipen

If your child has a severe requiring an epipen  please provide an Epipen/benadryl to the school office along with the Allergy Action Plan provided below.  This Allergy Action Plan must be completed by your doctor and renewed every year. If your child may require an Individualized Health Care Plan for precautions and accommodations in the classroom contact the school nurse.  

Allergy Action Plan

3. Seizure

If your child has been diagnosed with seizures and requires specific interventions at school, please have your childs physician complete the Seizure action plan below and contact the school nurse. 

Seizure Action Plan

4. Diabetes- Please obtain the (DMMP) Diabetes Management Plan for school from your doctor and contact the school nurse.