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.

Referral

Please notify the District RN of these new diagnoses/students by completing a referral.

Packets

ASTHMA
Asthma Packet
Asthma History 
Prescriber's Orders for Asthma 
Authorization for Nebulized  Medication 
Authorization for Medication Administration  (self administration AGREEMENT included)

ANAPHYLAXIS

Anaphylaxis Packet
Severe Allergic Reaction History
Authorization for Epinephrine
Prescriber's orders for Severe Allergic Reaction
AuthorizatIon for medication administratio (self administration agreement included)    

ALLERGIES
Allergy Action Plan
Authorization for Medication Administration


ADRENAL CRISIS
Authorization for Solu-Cortef                                                   


DIABETES
Authorization for Diabetic Care
Emergency Glucagon Authorization
Self-Management Contract
Authorization for Medication Administration

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


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 above should complete:
Authorization for Healthcare Procedures

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

Medication Administration Record
PRN Medication Administration Record 


















‚Äč