If your child has a diagnosed medical condition, please complete the appropriate health plan. All health plans include an authorization for medication administration if medication is required for that medical condition.

NOTE: KINDERGARTEN students should complete health plans in August (not earlier) so that the information is current and the health plans have been updated.

Asthma Action Plan (If student is self-administering medication, health care provider signature is required on this plan.)

Anaphylaxis & EpiPen Action Plan (to be completed by parents). Must also submit Health Care Provider Action Plan below.

Health Care Provider Action Plan for treating Anaphylaxis and EpiPen Administration (to be completed & signed by HC provider)

Seizure Management Plan

Diabetes Medical Management Plan (to be completed & signed by HC provider)

Allergy Management Plan

Health Management Plan (Use for medical conditions that are not among the list of health plans)