Forms
There are many diagnoses and conditions managed everyday in the school setting, some of the most common are listed below with applicable information and forms for new students or new diagnoses.
Please notify the District RN of these new diagnoses/students by completing a referral.

Any student with a chronic health condition that will require collaboration with their provider should complete an: 
Authorization to Disclose Health Information

Conditions with  clinical procedures not reflected below should complete:
Authorization for Healthcare Procedures

Students who will take medication daily or intermittently at school should complete an:
Authorization for Medication Administration

ADRENAL CRISIS
Authorization for Solu-Cortef

ALLERGIES
Allergy Action Plan
Authorization for Medication Administration

ANAPHYLAXIS
Authorization for Specialized Care for Severe Allergic Reaction
                                                                

ASTHMA
Asthma Action Plan
Authorization for Medication Administration  (self administration contract included)

DIABETES
Authorization for Diabetic Care
Emergency Glucagon Authorization
Self-Management Contract
Authorization for Medication Administration
Blood Glucose Logs Type 1
Blood Glucose Logs Type 2

SEIZURE DISORDERS

Authorization for Specialized Care for Seizure Action Plan
Authorization for Medication Administration
Seizure History Intake










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