Student's Health Concert

Asthma or Allergy Action Plan

Diabetic Care Plan

Dispensing Medication

Seizure Action Plan

Treatment or Procedure Authorization

Allergies:
Non-Food

X

X
(if applicable)

Allergies:
Food

X

X
(if applicable)

Asthma

X

X
(if applicable)

Health Concern: Medicated During School Hours

X
REQUIRED

Health Concern: Not Medicated During School Hours

Diabetes

X

X
(or equivalent)

Seizure Disorder

X
(if applicable)

X

Medical Treatment or Procedure required during school hours

X
(if applicable)

X