Health Forms & Documents:

Medication Authorization Form:
-Over the counter meds such as Tylenol/ibuprofen/etc., Form must be filled out
completely and signed by the parent before it can be given at school.

-Prescriptions to be taken for less than 2 weeks such as antibiotics, Form must be filled
out completely and signed by the parent before it can be given at school.

-Prescriptions to be taken longer than 2 weeks such as any ADHD medication, Asthma
Inhalers, Epi-Pens, Reflux medication, etc. Form must be filled out completely and signed by
parent and the Physician before it can be given at school.

Asthma Action Plan:
-Must be filled out completely and signed by the physician and be brought with the
student’s rescue inhaler/medication to school.

-If your child is in grade 6 or higher and can accurately identify their need to take a
rescue inhaler, take the prescribed dose appropriately, and can demonstrate this to their
physician, they may qualify for self-carry of their asthma inhaler according to Texas Education
Code - EDUC § 38.015. Self-Administration of Prescription Asthma or Anaphylaxis Medicine by
Students. If you believe they do, take the self-carry form to their doctor and have it signed.

Severe Allergy/Anaphylaxis Action Plan:
-Must be filled out completely and signed by the physician and be brought with the
students Epi-Pen or other prescribed medications to school.

-If your child is in grade 6 or higher and can accurately identify their need to take their
Epi-Pen, and can demonstrate this to their physician, they may qualify for self-carry of their Epi-
Pen according to Texas Education Code - EDUC § 38.015. Self-Administration of Prescription
Asthma or Anaphylaxis Medicine by Students. If you believe they do, take the self-carry form to
their doctor and have it signed.

Seizure Action Plan:
-Must be filled out completely and signed by the physician and be brought to school
with the student’s prescribed medications.

Diabetes Medical Management Plan:
-Most doctors have their own Diabetes Medical Management Plan they can give if you
ask, if not this is a generic form to be filled out and signed by the physician. We must have one
to appropriately treat your student’s blood sugars.

Health Screening Form

History of Chicken Pox Form

Permission to Travel Form

Permission to Self Carry Epi-Pen

Permission to Self Carry Inhaler

Required Immunizations