Health Care Plans

Registration Health Form: This form must be printed and turned into the front office or to the school nurse yearly. This form is required for all students.

Health care plan forms must be submitted annually. Please print and return to the front office or to your school nurse. All health care plans require a parent and healthcare provider signature

EPICC Program (Utah Department of Health)

Allergy Health Care Plan Forms

Please submit “Allergy & Anaphylaxis Emergency Action Plan” and “Epinephrine Authorization Form”. 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

Health Assessment Form

Lunchroom Accommodations

Medical Release Form

Medication Administration Authorization Forms

Medication Forms for School Nurses

Seizure Health Care Plan Forms

Transportation Forms