Peanut/Nut Allergy Packet 

• Anaphylaxis Emergency Action Plan 
• DVUSD Special Diet Accomodations Information 
• Medication Administration Record
• Medical Authorization to Administer Medication or Dietary Supplement
• Student Severe Allergy History
• Special Diet Request
• Peanut/Nut Free Table Form
• NASN School Guidelines for Managing Food Allergies Information

COVID-19 Packet

• DVUSD Parent/Guardian Reporting Form 
• Email School Nurse: Vanessa.Salazar@dvusd.org
• Home Isolation Guidance for people with COVID-19 - MCDPH
• Quarantine Guidance for Household and Close Contacts - MCDPH
• How Long Should I stay Home Interactive Tool - MCDPH

Food Allergy Packet

• Anaphylaxis Emergency Action Plan
• DVUSD Special Diet Accomodations Information
• Medication Administration Record
• Medical Authorization to Administer Medication or Dietary Supplement
• Student Severe Allergy History
• Special Diet Request
• NASN School Guidelines for Managing Food Allergies Information

Severe Allergy Packet

• Anaphylaxis Emergency Action Plan
• Medication Administration Record
• Medical Authorization to Administer Medication or Dietary Supplement
• Student Severe Allergy History

Chronic Condition - Asthma Packet

• Asthma Action Plan
• Medication Administration Record
• Medical Authorization to Administer Medication or Dietary Supplement
• Letter to Parents - Information
• Updated Health Center Policies As Related to COVID-19 - Please Read

Chronic Condition - Diabetes Packet

• Diabetes Questionnaire
• Technology Use Agreement
• In the Absence of the Nurse
• Diabetes Self Managment
• Diabetes Supply Check List
• Diabetic Treatment Plan
• Diabetic Bus Rider
• Diabetes Quick Look Form

Chronic Condition - Seizure Disorder Packet

• Student Individual Emergency Medical Plan
• Student Seizure Information Sheet
• Medication Administration Record
• Medical Authorization to Administer Medication or Dietary Supplement

Medication Administration Packet

• Medication Administration Record
• Medical Authorization to Administer Medication or Dietary Supplement

Questions

Do not hesitate to call or email with any questions regarding applicable forms needed for your child. 

Forms may be printed from this page or picked up in the Health Office.

Health Office: 623-445-5510

Email: Vanessa.Salazar@DVUSD.org