Last modified: June 21, 2023

Health & Medical Forms

Allergy and Anaphylaxis

• Allergy and Anaphylaxis Emergency Action Plan (English)
• Allergy and Anaphylaxis Emergency Action Plan (Spanish)

Asthma

• Asthma Action Plan (English)
• Asthma Action Plan (Spanish)

Diabetes

• Diabetes Individualized Healthcare Plan (English)
• Diabetes Individualized Healthcare Plan (Spanish)
• Diabetes Emergency Action Plan (English)
• Diabetes Emergency Action Plan (Spanish)
• Continuous Glucose Monitor Addendum (English)
• Continuous Glucose Monitor Addendum (Spanish)
• Pump/Smart Pen Addendum (English)
• Pump/Smart Pen Addendum (Spanish)
• Injection Addendum (English)
• Injection Addendum (Spanish)

Maturation

• 5th Grade Maturation Program

Medications

• Medication Authorization Form (English)
• Medication Authorization Form (Spanish)

Seizures

• Seizure Action Plan (English)
• Seizure Action Plan (Spanish)
• Seizure Medication Management Order (English)
• Seizure Medication Management Order (Spanish)

Vision Screening

• Vision Screening Opt-out Form
• Vision Screening Referral Form (English)
• Vision Screening Referral Form (Spanish)
• Vision Symptoms Questionnaire (English)
• Vision Symptoms Questionnaire (Spanish)

Miscellaneous Forms

• Medical Release Form
• Generic IHP EAP Form (English)
• Generic IHP EAP Form (Spanish)
• Medical Diagnosis Confirmation
• Student Health Information (English)
• Student Health Information (Spanish)
• Special Dietary Request Checklist