Park City School District

Health Care Plans and Forms


Please submit the state required Asthma Self Administration Form annually..

Concussion Care Plan

G-Tube Feeding Order


Please submit the Diabetes School Health Care Plan and state required Glucagon Authorization if requesting to have Glucagon at school annually.


Food Allergy

If your student requires an Epi Pen you must submit an Epi Pen Authorization form. If your student requires an inhaler you must submit the Asthma Self Authorization form. All medications given for an allergic reaction must be written on the Food Allergy Action Plan. All forms must be signed by your doctor and submitted annually.

Medication Administration

Medication Forms for School Nurses

Seizure Care Plan

Please submit Seizure School Health Care Plan signed by your doctor annually.

Vision Screening