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Health Conditions

If your child has a medical condition, please fill out the appropriate Confidential Student Health Information Form and Health Questionnaire. By informing the health office of the student’s health condition, we can work together to manage their care during the school day. If your child requires medication at school, the Authorization for Administration of Medication Form will need to be completed by the ordering provider and parent/legal guardian. You can find the medication forms under the Medications Tab. Below you will find the forms that the health office will need to have on file for your student’s medical condition. Please return the forms to the appropriate health office prior to school starting.

All Medical Conditions

Confidential Student Health Information Form (Elementary)

Confidential Student Health Information Form (Secondary)

Allergy

Allergy Questionnaire

An Allergy Action Plan from the student's medical provider. Medical providers may use this AAP Action Plan if needed. 

**If your student needs a lactose reduced milk or a complete food substitution due to a diet allergy, please visit the Dietary Accommodations section on the Nutrition Services Webpage for the appropriate forms. 

Asthma

Asthma Questionnaire

An Asthma Action Plan from the student's medical provider. Medical providers may use this MDH Action Plan if needed

Diabetes

Diabetes Questionnaire

Diabetic Agreement 

Student specific diabetic orders/action plan from medical provider. 

Self-Management of Diabetes Agreement (this form is optional, for students in grades 7-12th only, who are independent in managing their diabetes) 

Seizures

Seizure Questionnaire 

A Seizure Action Plan from the student’s medical provider. Medical providers may use this Epilepsy Foundation Action Plan if needed.

Concussions/Head Injuries

  • Concussion/Traumatic Brain Injury (TBI) Questionnaire

  • If your student was recently diagnosed with a concussion, head injury and/or a TBI and is needing accommodations while in school, please provide the health office with the accommodations from a medical provider/athletic trainer. 

 All Other Health Conditions Not Listed