Laird, Jen - Nurse
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FORMS (Please complete after July 1, 2024 for the upcoming school year)
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- All prescription medications, including Asthma and Allergy medications and dietary supplements, must have a written order from the physician stating the name of medication, the dosage, and the time to be given.
- Please fully complete and sign the medication forms and bring them to the Health Office.
- Medicine must be in the original bottle as prescribed by a physician or in the original over-the-counter bottle.
- We cannot accept expired medication.
- Parents are responsible for bringing in medication, including cough drops, to the Health Office.
- All medication must be distributed by the nurse, unless addressed in a medical-assistance plan.
Medication Doctors Order Form:
Dr. signature required on the medication authorization form
Mar Log for health office
All medical packets below will need a medication doctor order form (above) if you are planning on having medications for your student in the health office.
Allergy Packet (need epi pen, benadryl, etc.)
Allergy history
https://drive.google.com/file/d/1aZa53mIocOCe73QZjPAAcWyCXXI_uA8k/view?usp=sharing
Action Plan (Dr. signature required)
https://drive.google.com/file/d/1Rzo-PoQkmoMPzbFx3tTvsTqOdIQ_FrZB/view?usp=sharing
Peanut/Nut Allergy Cafeteria table seating
https://drive.google.com/file/d/1zWya2-3Whm9iz8f2TEpsW-WiXQI1u6B-/view?usp=sharing
Special Diet Request for known Allergies only (Dr. signature required)
https://drive.google.com/file/d/1mLW4ot_CJCf6LKntFdZYi8I8oH4p1RTb/view?usp=sharing
Asthma
Action plan for school (Dr. signature required)
Self-carry inhaler/epi pen authorization
Diabetes (a plan from your provider is also accepted, but a plan must be on file for the school year and updated whenever there are changes)
Absence of Nurse
Technology Agreement
Diabetes Questionnaire
https://drive.google.com/file/d/1E0GYn0jMS1uAUP9xbmEx-huF8BE_s8X9/view?usp=sharing
Diabetic Treatment Plan (Dr. signature required)
https://drive.google.com/file/d/1ZJudhQDMsH2_aMmwY6V6w1YUuZKW5TLD/view?usp=sharing
Self Management (Dr. signature required)
https://drive.google.com/file/d/1k9ofunpSe8IHHnd0yJ18yymX1kJ3RIEt/view?usp=sharing
Bus Rider form
https://drive.google.com/file/d/1I3KBkBb6qlpFXoiqYWYnRPoeyJF4riFj/view?usp=sharing
Supply Checklist for school/all classrooms (each classroom from 4th grade and above will need supplies in the event of an emergency, including special areas)
Seizures
Action Plan for School (Dr. signature required)
Seizure information sheet
Student Individual Emergency Medical Plan (Dr. signature required) all other medical conditions that may require a plan in place for school
https://drive.google.com/file/d/1kA-1OMxucoFjfh4d5yWVQyX9LzDFUC5x/view?usp=sharing
Bus Rider Form for Allergies, Seizures, Asthma
https://drive.google.com/file/d/1sGvVYefXgh9XRjNSUKz5oPCt6ep2JKT_/view?usp=sharing
* The forms above must be completed on or after July 1, 2024 for the upcoming school year. If dated prior to July 1, 2024 the forms will need to be resubmitted. Thank you.*