Park City School District

Health Care Plans

Please submit health care plan forms annually. All health care plans require a parent and healthcare provider signature

Allergy Health Care Plan Forms

Please submit "Allergy & Anaphylaxis - Emergency Action Plan." If your student requires lunchroom accommodations submit the "Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions." If your student rides the bus submit the "Allergy Bus Form." If your student has asthma submit the "Asthma Action Plan." These forms must be completed annually with parent and healthcare provider signature.

Asthma Health Care Plan Forms

Please submit the state required Asthma Action Plan Medical Authorization & Self-Administration Form annually..

Concussion Management Plan Forms

Diabetes Health Care Plan Forms

Generic Health Care Plan

G-Tube Feeding Order and Forms

Headache/Migraine Health Care Plan


Lunchroom Accommodations

Medical Release Form

Medication Administration Authorization Forms

Medication Forms for School Nurses

Seizure Health Care Plan Forms

Transportation Forms