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Girard USD 248

District

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Forms

***Medication in School***  

If you would like your child to be given medication at school, please fill out one form per medication per child. If it is a prescribed medication, it will also require the Physician's signature. See the instructions for medications in school by clicking here.

Medication Consent Form

If it is necessary for us to administer your child's daily medication OR if you would like to leave medication in the Health Office for an as needed basis, such as Tylenol or Ibuprofen, then you will need to fill out one form per child, per medication. The prescription medications will need to be signed by your ordering physician. 

Emergency Medication Self Carry Release Form

If it is necessary that your child carry their own emergency medication with them during school hours, such as an epi pen or inhaler, etc. then please fill out this form. One form per medication, per child. The ordering physician will also need to sign this form.

Health Intake Form

To be filled out with any new student and with any new medical update or change in student's health history.

Health Assessment Form (Physical)

To be filled out with any new student under the age of 9 and for yearly for any student participating in school sports. May use the forms from your doctor's office as well.

 

Care Plans

Asthma

Asthma Action Plan (To be filled out and signed by your physician)

https://www.nhlbi.nih.gov/files/docs/public/lung/asthma_actplan.pdf

 

Allergies/Anaphylaxis

Epi Pen Action Plan (To be filled out and signed by your physician)

https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Libraries/Anaphylaxis-Emergency-Action-Plan.pdf

 

Diabetes

Insulin Action Plan 

http://www.choosehealth.utah.gov/documents/pdfs/school-nurses/DMMO%20emergency%20action%20plan.pdf

Diabetes Medical Management Plan

https://www.idph.state.ia.us/hcci/common/pdf/sample_diabetes.pdf