Health Services Plan Permits

The following forms are available for you to print and complete. In addition to parent input, some of the individual health care plans require completion by, and a signature from, a physician.

Contact your School Nurse if you have questions or concerns. Return the completed care plans to your school nurse as soon as possible.

The parent is responsible for informing the school of medical care that is needed and for completing the care plans.

Licensed health care providers’ orders are required for specialized health services such as Epi-pen injection, self administration of medications during school, blood glucose monitoring (insulin administration), gastrostomy tube feedings, clean intermittent catheterizations, nebulizer treatments, food allergies, etc.