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.
Permission to Self Carry Epi-Pen