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Medical Forms

Medication Administration Form

This form is used for all medications, prescriptions or over the counter that your child will be using here at MACS. Please include asthma medications and epipens on this form. You need to use this form in conjunction with another for asthma or allergies and doctor orders. 

 

Asthma Action Plan

You will have your child's doctor fill this form out for asthma. This form should be returned to the school with the medication administration form. 

 

Asthma/Anaphylaxis Self-Carry Form

Please fill this form out if you want your child to self-carry his/her asthma or anaphylaxis medication. The child must demonstrate the ability to administer the medication properly to their doctor and the school nurse. Please fill out the asthma and/or food allergy action plan and medication administration forms as well. 

 

Food Allergy & Anaphylaxis Emergency Care Plan- English       

Food Allergy & Anaphylaxis Emergency Care Plan- Spanish

This is for any food allergy & anaphylaxis we should know about. Often accompanies Epipen. You will have your child's doctor fill this form out for food allergies. This form should be returned to the school with the medication administration form. 

 

Seizure Action Plan

 

Beginning of the year forms (all students to be filled out)

Health Questionnaire

Parent Authorization for Standing Orders (please read carefully)

This is only for over the counter first aid medications such as hydrocortisone or cough drops. Parents will provide all other medications, including Tylenol and Ibuprofen, for their child (ren) throughout the school year, with proper documentation required by the school.

The following are medications that our standing orders will cover at this time. These medications will need to be brought by the parents if needed. Any other medications will need a doctor’s order along with the proper paperwork.

  • Cetirizine (Zyrtec)
  • Diphenhydramine (Benadryl)
  • Acetaminophen (Tylenol)
  • Ibuprofen (Motrin)
  • Pepto
  • Tums