• Health Related Needs During the School Year

    Medication Use at School: Daily medication or as needed medication given at school must have a matching medication authorization form completed annually and on file. The form must be signed by both a parent/guardian and a doctor, even for over the counter medication. An accompanying supply of medication must be provided to the school by parent/guardian.

    • All medication must be given to the school in its original bottle/container 
    • Please check expiration dates on medications before turning them in to the office
    • A new medication authorization form and/or emergency plan is required yearly
    • Medication that requires modification prior to administration (ie. cutting a pill), must be pre-delivered to the office in such a way

    Allergy/Anaphylaxis: If your child has a life-threatening or severe allergy that may require epinephrine or other medication administration, we must have an allergy emergency action plan on file that is signed by a parent/guardian and a doctor. You must provide an epinephrine auto-injector and any other medications listed in the plan (i.e. Benadryl), to keep in the main office clinic.

    Epilepsy/Seizure: An annual seizure action plan signed by a parent/guardian and a clinician must be on file. Accompanying medication(s) referred to in the plan must also be provided to the school. 

    Diabetes: An annually updated Diabetic Medical Management Plan (DMMP) must be on file that is signed by a parent/guardian and a doctor. Parent/Guardians must supply an emergency glucagon kit that is prescribed by the student’s managing clinician. Parent/Guardians are also responsible for supplying diabetic care items and any snacks or drinks for hypoglycemic episodes.

    Asthma: A prescribed, unexpired inhaler should be provided for school. An accompanying medication authorization form must be completed and signed by a parent/guardian and a doctor.

    Physician’s Authorization for Procedures: This form should be completed in the event your child requires a specialized healthcare procedure be performed during the school day or in the event of an emergency. It must be completed annually and signed by a clinician and parent/guardian.

    *When an emergency action plan is completed, it is NOT necessary to complete a separate Medication Authorization Form for any medication already included in an action plan (e.g., inhaler, EpiPen, Glucagon, Diastat, Benadryl, etc.).

    Health Forms and Action Plan Templates

    District Medication Authorization Form

    Severe Allergy/Anaphylaxis Action Plan

    Seizure Action Plan

    Diabetic Medical Management Plan

    Asthma Action Plan

    Physician's Authorization for Procedures at School

    MHSAA Sports Physical Form

    Michigan Child Health Appraisal Form

    Kindergarten Oral Health Assessment (KOHA) Form