Medication Forms

  • Please refer to the following forms if your child requires medication be kept / given at school.  These forms should be completed by the parent/guardian as well as the private MD.  All Medication Request forms will be cosigned by the district's medical doctor as well. Please have your student's physician complete one form for each medication and the appropriate action plan as described below.

    Medication Administration Form

    These forms should be filled out by you AND your child's MD if they require medication to be kept and given at school.  Each medication requires a separate form.  This may include daily medications or emergency medications such as epinephrine, albuterol etc.

    Self Administer/Indemnification Form

    This form should be filled out if your child will be administering their own medication; i.e. insulin, or keeping it on them at school i.e. albuterol.

    Food Allergy Action Plan

    This form must be filled out by MD if your child has food allergies.

    Asthma Action Plan

    This form must be filled out by MD if your child has asthma

    Diabetes Medical Management Plan

    These forms should be completed/signed by students' parent/guardian and private MD for diabetes management at school (Or another plan provided by MD).

    Seizure Action Plan

    This form should be filled out by MD if your child has epilepsy or seizures (Or another plan provided by MD).