Medical Action Plan Forms
Medical Action Plans (MAPs) are required every school year for medical treatment at school. MAP forms for the 2016-2017 school year are posted below. Forms must be completed by a physician.

Please return the MAP to the office of the school location of which your student is currently attending, it will remain until the end of the school year.

ADD/ADHD Health Care Plan(pdf)

Asthma Plan of Action(pdf)

Bee Sting Allergy Plan of Action(pdf)

Diabetes Plan of Action(pdf)

Food Allergy Plan of Action(pdf)

General Plan of Action(pdf)

Seizure Plan of Action(pdf)

Authorization for Prescribed Medication or Treatment

Release of Medical Information
HIPAA Compliant Authorization for Exchange of Health & Education Information

Medication Administration
Self-administration means that the student can administer the medication in a manner directed by the physician without additional direction or supervision by school staff. See form below.

Medication Prescriber/Parent Authorization Form for Self-Administration/Self-Possession(pdf)

Medication Prescriber/Parent Authorization Form(pdf)

Health Appraisal

General health evaluation to be completed by physician for enrolling Kindergarten students.

Health Appraisal (pdf)

Volunteer Form

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