Medical Forms

“Health-care services,” as used in TEC, Section 26.009, mean services that involve medical treatment, medical procedures, or dispensing medication. Health-care services will not be provided unless you “opt in”, providing written consent in advance for any of these services to be made available for your child. “Opt-in” means a process where a parent actively grants informed consent for their child to participate in or receive a service prior to the delivery of that service. You can update your decisions at any time. 

“Health-care services” offered on your child’s campus consist of the following.

• First Aid Medication Administration (form sent out at the beginning of school year)
• Over the counter Medication Administration that a parent brings in for student
• Prescription Medication Administration that a parent brings in for student with doctor order to be given at school
  • Asthma medication (with Asthma Action Plan)
  • Epinephrine pens or nasal sprays (with Allergy Action Plan or FARE form)
  • Seizure medication (with Seizure Action Plan)
  • Any other prescription medication
• Medical Procedures (parent to supply medical supplies for procedure with doctor order to be administered at school)
• Any other specialized service needed at school 

Please contact the school nurse for any medication that your student will need to be given at school. There will need to be proper paperwork filled out before that medication can be left at school. Some medications will need to be signed in and out for, and some will need to have orders from a doctor prior to being left. Please do not give any medications to your child to bring in to the nurse. You must walk in all medications that are needed at school to ensure that paperwork needed is completed.  

 

 

Medication Administration Form

This form is used for all medications, prescriptions or over the counter that your child will be using here at MACS. Over the counter medications no longer require physician orders. 

Physician Order Form

This form is for any medications that are prescriptions that you need your child to take at school. Please remember that medications that can be taken at home, should be taken at home, for example medications that are 24 hours, or antibiotics that can be taken before and after school.

 

Asthma Action Plan

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

Food Allergy & Anaphylaxis Emergency Care Plan- English       

If your child has a food allergy or a severe food allergy that, in your judgment, would require immediate medical attention if the student were exposed to the allergen, we will ask you to disclose that information, including the food to which the child is allergic and the nature of the allergic reaction, at enrollment so that we may take necessary precautions for the child’s safety. 

Asthma/ Anaphylaxis Self-Carry Form  

Please fill out the asthma or Allergy action plan and medication administration form as well.

Children with asthma or children with severe allergies that may result in anaphylaxis will be allowed to carry and self-administer their prescription asthma or anaphylaxis medicine under certain conditions. The student must have demonstrated to his or her doctor and to the school nurse that the child has the skills necessary to self-administer the asthma or anaphylaxis medicine. Additionally you must provide us a written authorization for self-administration and a written statement from child’s doctor that the student has asthma and is capable of self-administration and that includes the name and purpose of the medicine, the prescribed dosage, the times and circumstances for administration, and the period for which the medicine is prescribed. 

 

Seizure Action Plan

 

Medical Procedure Form

This form is for any medical procedures that are to be performed at school per physician recommendations. These should have a 504 plan in place. 

 

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

Health Questionnaire - Blue cards you may get from Grace or the Nurse

Parent Authorization for Standing Orders (please read carefully)

 

Screening Forms

Health-Related Services Parental Opt-Out Form

Hearing/ Vision Screen Waiver Form (must be signed by doctor)

Hearing/ Vision Screen Religious Exemption Form (must be notarized)

Acanthosis Nigricans Religious Screen Exemption Form (must be notarized)

Spinal Screen Religious Exemption Form (must be notarized)

 

Please contact the nurse if you have any questions at 432-686-0003.