DIABETES

Diabetes Medication Management Order (DMMO): This form may be provided digitally by physicians per parent request. Please contact the individual school for the email and/or fax number to send it to.

Diabetes Individualized Health Plan (IHP): This form is to be completed in collaboration with the parent and the school nurse.

• Diabetes CGM Addendum to the IHP is needed if the student uses a continuous glucose monitor.

• Insulin Injection Addendum

• Insulin Pump- Smart Pen Addendum

Diabetes Emergency Action Plan (EAP): This form is to be completed in collaboration with the parent and the school nurse. 

ASTHMA

Asthma Action Plan with Medication Authorization Form: This form is used if the student requires intense monitoring or support due to their asthma condition, and required if the student uses an inhaler while at school.

FOOD ALLERGIES

Allergy and Anaphylaxis Health Plan and Epinephrine Authorization: This form is not valid without parent and prescriber signatures.

SEIZURES

Seizure Health Plan : This form is required for students who are currently experiencing seizures. 

Seizure Medication Management Order (SMMO): This form is required if the student has seizure rescue medication ordered. The form is not valid without parent and prescriber signatures. 

STUDENT NEEDS MEDICATIONS WHILE ATTENDING SCHOOL

Medication Authorization Form: This form is required for any medications other than Tylenol that have to be administered while a child is at school. The form is not valid without parent and prescriber signatures. 

STUDENT NEEDS A SPECIAL DIET WHILE ATTENDING SCHOOL

Special Meal Request Form: This form is not valid without parent and prescriber signatures. 

Checklist for Foods to Exclude and Substitute: This form is not valid without parent and prescriber signatures.