Please print out and complete the care plan(s) that applies to your child’s medical condition.
Cardiac Care Plans must be completed and signed by your students Cardiologist. All other Care Plans may be completed by parent/guardian. Please provide as much detailed information as possible to better help school staff to care for your child at school.
Return completed Care Plans to your student’s school clinic
MEDICATIONS AT SCHOOL:
All medications to be administered at school prescribed or over the counter require a completed Medication Authorization Form signed by your students Doctor.
The Doctor's orders must include:
Name of the medication
Exact dose (no dose ranges will be accepted ex 1 to 2 pills or 2 to 4 puffs)
Daily medications must include the exact time of administration at school
As needed medications must include the specific time frame to be given at school (ex every 4 hours as needed) Orders may not say "as needed” without a time frame
If your student's medication needs to be crushed or capsules opened for administration this must be stated in the Doctor’s order
CONTRACT TO CARRY ORDERS MUST BE SUBMITTED WITH A MEDICAITON AUTHORIZATION FORM
INSTRUCTIONS ON THE PILL BOTTLE MUST MATCH THE DOCTOR'S ORDERS EXACTLY OR THEY WILL NOT BE ACCPEPTED BY CLINIC STAFF.
ALL MEDICATION ORDERS MUST BE APPROVED BY THE SCHOOL RN PRIOR TO BEING ADMINISTERED BY CLINIC STAFF
Medications must be brought to school by an adult, students may not bring medication to school this included over the counter medications unless they have a Contract to Carry on file in the clinic.
ALL FORMS MUST BE DATED AFTER JULY 1ST FOR THE UPCOMING SCHOOL YEAR AND RENEWED YEARLY
If you have any questions please contact your schools clinic staff
Allergy Care Plan 2020.pdf
409.2 KB, uploaded July 21, 2020 12:54 PM (updated August 24, 2020 9:13 AM)
Asthma Care Plan 2020.pdf
354.34 KB, uploaded July 21, 2020 12:54 PM (updated November 23, 2020 9:08 AM)
Authorization for Administration of Prescribed MedicationTreatment SO-SS-007.pdf
459.01 KB, uploaded July 21, 2020 3:17 PM (updated August 24, 2020 11:22 AM)
328.68 KB, uploaded July 21, 2020 12:54 PM (updated September 2, 2020 6:19 AM)
Care Plan and Medication Forms Instructions.pdf
277.32 KB, uploaded July 21, 2020 12:54 PM (updated September 2, 2020 6:22 AM)
CONTRACT TO CARRY AND SELF-ADMINISTER ASTHMA INHALER OR EPI-PEN, PANCREATIC ENZYMES, DIABETIC SUPPLIES SO-SS-100.pdf
18.04 KB, uploaded July 21, 2020 3:17 PM (updated September 2, 2020 9:36 AM)
Diabetes Care Plan 2020.pdf
548.51 KB, uploaded July 21, 2020 12:54 PM (updated September 3, 2020 4:26 AM)
Food Allergy Care Plan 2020.pdf
761.11 KB, uploaded July 21, 2020 12:54 PM (updated September 3, 2020 10:51 AM)
Generic Care Plan 2020.pdf
319.93 KB, uploaded July 21, 2020 12:54 PM (updated September 4, 2020 9:00 AM)
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