Health Forms and Regulations

If your student has a condition that you cannot find a form for, please contact the nurse as soon as possible.

Medication Administration at School Regulation 757-4
Authorization for Medication Administration (Must be submitted with each medication and health treatment plan)
Medication Permission Form for Extended Day/Overnight Fieldtrips

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ASTHMA
Asthma in the School Setting Regulation 757-3
Virginia Asthma Action Plan
Authorization to Implement Health Treatment Plan (must be submitted with completed action plan)

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ALLERGIES
Allergic reactions in the school setting Regulation 757-2
Allergy History Form
Food Allergy & Anaphylaxis Care Plan
Parent/Guardian Request for Administration of Medication for Allergic Reactions
Permission for Student to Carry and/or Self Administer Epinephrine
Severe Allergy Individual Health Care Plan

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EPILEPSY
Epileptic seizures in the School Setting Regulation 757-7
Seizure Action Plan

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DIABETES
Management of Diabetes in School Regulation 757-6
Diabetes Medical Management Plan
Diabetes Treatment Log (PDF)
Insulin Pumps and/or Continuous Glucose Monitors

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CANCER
Management of Students with Cancer in School Regulation 757-8
Cancer Care Plan (PDF)

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HEALTH/EMERGENCY TREATMENT PLANS
Management of Students with Health Treatment Plans Regulation 757-3
The following are for the treatment and/or procedures that cannot be managed with the Health Treatment Plans listed above.

Authorization to Implement Health Treatment Plans
PWCS Clean Intermittent Catherization
Tube Feeding
Authorization for Specific Medical Procedure
Authorization and Consent for Exchange & Release of Medical Information