HEALTH ROOM DOCUMENTS

MEDICATION:

• Prescription Medication: This form is used for medications that require a prescription and should be filled out with your student’s physician. Please ensure that as a parent/guardian you are also signing both sides of the form. When updates are made to the students prescription medications, a written prescription from the physician must be provided to the school nurse. This is to ensure that your student is having the proper medications administered at the right time and right dosage. All medications are required to be brought in by an adult. Students are not allowed to travel on the bus with any medication in their backpacks. All medications are required to be in their properly labeled prescription bottles. 

• Non-Prescription Medication: This form should be used for over the counter medications and medications that do NOT require a physician signature. Such items are for example, Tylenol, Ibuprofen, Tums, Lactaid, etc. Due to specific regulations on Tylenol and Ibuprofen containers, children under 12 will need Children's Medications. We require that all families supply their own medication. If your family supplies any medication, it must be kept in the original container, not expired, and labeled with your student's name. All medications are required to be brought in by an adult. Students are not allowed to travel on the bus with any medication in their backpacks. 

ASTHMA:

• Asthma Action Plan: This plan ensures that staff knows how to effectively assist your student in their time of need during an asthma attack. Please fill this out with your student’s physician.
• Prescription Medication Form: This form is found above and needs to be filled out for inhalers or nebulizers - even if student self carries. Please ensure that all medications are labeled with the correct prescription. 

FOOD ALLERGY:

• FARE Documentation: This form needs to be completed for any and all food related allergic reactions that may require the use of epinephrine or Benadryl. 
• Allergy Management Plan: This form needs to be filled out if the allergen is food related with or without the need for epinephrine or Benadryl. If your child has gluten or dairy allergies that do not require epinephrine, you would only fill out this form. This form is submitted to our Nutritional Services Department as well as the School Nurse.
• Special Dietary Need Statement: This form will be filled out with your student’s physician. This allows our Nutritional Services staff to correctly and appropriately ensure that your student has the right products for their dietary and/or medical needs.
• Prescription Medication Form: This form is found above and needs to be filled out for epinephrine and/or Benadryl - even if student self carries. Please ensure that all medications are labeled with the correct prescription.

NON-FOOD ALLERGY:

• Allergy Action Plan: This form needs to be completed for any and all food related allergic reactions that may require the use of epinephrine or Benadryl.
• Prescription Medication Form: This form is found above and needs to be filled out for epinephrine and/or Benadryl - even if student self carries. Please ensure that all medications are labeled with the correct prescription.

SEIZURE:

• Seizure Action Plan: This form is required for students who have a seizure disorder to ensure the safety of your student if they were to experience a seizure during the school day. This document lays out information on what type of seizure disorder your student has been diagnosed with, what emergency medications your student has, which medical facility that you would like your student transported to during or after a seizure. We ask that all seizure emergency medications come in their original container with the proper label attached. If a student does experience a seizure and emergency medications are used, Altoona School District policy states that Emergency Medical Services (911) will be called. 
• Prescription Medication Form: This form is found above and needs to be filled out for any emergency medication that will be kept at school. Please ensure that all medications are labeled with the correct prescription.

DIABETES:

• Diabetes Management Plan: This form is required for students who have diabetes to ensure the safety of your student during the school day. This document will guide the School Nurse and trained staff on insulin dosing, carb counting, and other student specific information. 
• Prescription Medication Form: This form is found above and needs to be filled out for any emergency medication that will be kept at school and/or insulin - even if student self carries. Please ensure that all medications are labeled with the correct prescription.

PLEASE NOTE: All medical documents need to be updated on a yearly basis. All medications need to be picked up on or before the last day of student attendance. All medication (prescription and non-prescription) will be disposed of according to the WI Department of Natural Resources ONE WEEK after the last day of school. Please coordinate with the School Nurse for pickup.