Western Placer Unified School District - Student Health Concerns & Medications

Health Care Plans & Required FormsTop of Page

Welcome Note

At Western Placer Unified School District we take the health and safety of our students very seriously. In order to ensure your students medical concerns and safety is met, it is requested that we have the appropriate care plan and medication on file to meet that need.

Please use the above tabs to guide you in the paperwork that is needed. Once the paperwork is completed by both the parent or legal guardian and health care provider, please return them to the school office.

If you do not see a care plan that meets the need/s of your student please contact the main office at your student’s school.

Allergies

What is the parent or legal guardian’s responsibility?

Notify the school that your student has a severe allergic reaction (anaphylaxis) to a known or unknown substance
Obtain the Allergy Action Care Plan and Administration of Medication form
Bring the medication, in the original pharmacy container, that your student may need during school hours. Medication cannot be dropped off by the student
In case of an emergency, you may need to provide your home, work, cellular and/or contact numbers
Keep the emergency card current and immediately notify the school of any changes
Keep the school updated on any changes in your student’s health condition

What is the school’s responsibility?

Provide a safe environment for your student
Have an emergency plan for your student
Notify appropriate school personnel of your student’s severe allergy
Call if your child receives emergency treatment or if your child needs to go home
Call your designated emergency contact if you are not available
Notify you of special programs, such as field trips or class activities

How can the Registered Nurse help?

Assist in the development of your student’s emergency plan and medications to be used at school
Arrange for appropriate training of school personnel to respond in an emergency
If you and your doctor have requested that your student carry his/her own medications, notify teacher and other trained staff
Communicate with you and/or your student’s doctor when needed

Please take the following documents to your student’s health care provider for completion. If your student is able to carry and self-administer the medication please be sure to indicate that on the form. Once the care plan and medication administration form is completed please bring the forms and medication, in a pharmacy labeled container, to the main office. All medication, unless authorized to carry, must be dropped off and signed in by a parent or legal guardian.

Allergy Action Care Plan

Administration of Medication Form

*If your student requires accommodations for school lunches please submit a Food Allergy/Disability Substitution Request

Asthma

Well-managed asthma is far less likely to result in a sick day. When kids' asthma is under control, they have a minimum of flare-ups and fewer problems between them.

Other benefits of proper asthma control include helping kids to:

Sleep well at night and focus at school during the day
Spend time at school in the classroom, not the nurse's office
Avoid anxiety or embarrassment about flare-ups and asthma symptoms
Study, run, play sports, and fully participate in all school activities

What is the parent or legal guardian’s responsibility?

Notify the school that your student has asthma and notify them if you would like to have an Asthma Action Care Plan on file
Bring your Asthma Action Plan to the school
Obtain the Administration of Medication form signed by your student’s doctor
Bring the medication, in the original pharmacy container, that your student may need during school hours. Medication cannot be dropped off by the student
In case of an emergency, you may need to provide your home, work, cellular and/or contact numbers
Keep the emergency card current and immediately notify the school of any changes
Keep the school updated on any changes in your student’s health condition

What is the school’s responsibility?

Provide a safe environment for your student
Notify appropriate school personnel of your student’s need for medication
Have an emergency plan for your student in case of an asthma attack at school
Call you if your student needs to go home
Call your designated emergency contact if you are not available
Notify you of special programs, such as field trips or class activities

How can the Registered Nurse help?

Review your student’s Asthma Action Plan and medications to be used at school
Make sure that your student knows how to properly use his/her asthma medications
Notify the teachers and other appropriate school personnel if you and the doctor have requested that your student carry his/her own medication

Please take the following documents to your student’s health care provider for completion. If your student is able to carry and self-administer the medication please be sure to indicate that on the form. Once the care plan and medication administration form is completed please bring the forms and medication, in a pharmacy labeled container, to the main office. All medication, unless authorized to carry, must be dropped off and signed in by a parent or legal guardian.

Asthma Action Care Plan

Administration of Medication Form

Diabetes

What is the parent or legal guardian’s responsibility?

Notify the school that your student has diabetes
Obtain the forms: Administration of Medication and Diabetes Medical Management Plan
Bring the needed supplies and medication, as listed on the protocol to school
Keep the school updated of any changes in your student’s health status or diabetic plan
In case of an emergency, you may need to provide your home, work, cellular and/or contact numbers
Keep the emergency card current and immediately notify the school of any changes
Keep the school updated on any changes in your student’s health condition

What is the school’s responsibility?

Provide a safe environment for your student
Develop an individual plan for your student’s diabetic care needs during the school day
Have an emergency plan for your student
Call your designated emergency contact if you are not available
Notify you of special programs, such as field trips or class activities

How can the Registered Nurse help?

Assist in the development of your student’s diabetic plan
Arrange for appropriate staff education/training regarding your student’s diabetic care
Review your student’s plan for use when a nurse is not at the school site
Communicate with you and/or your student’s doctor when needed

Please take the following documents to your student’s health care provider for completion. Once the care plan and medication administration form is completed, please bring the forms and any supplies, emergency medication or insulin that will need to be kept in the main office. All medication and/or supplies will need to be brought in the original labeled container, to the main office. All medication, unless authorized to carry, must be dropped off and signed in by a parent or legal guardian.

Administration of Medication

For students that are independent with care: Diabetes Medical Management Plan

For students that will require assistance: Diabetes Medical Management Plan

For a student using insulin, diabetes must be managed 24/7, including the many hours spent at school, on field trips and in extra-curricular activities.

Some families can send their child with diabetes to school in the morning and feel confident that the school will be prepared to provide the diabetes care that meets their child's needs. Other families worry that their child won't have access to good diabetes management, that their child will be excluded from activities or have to take an exam when blood glucose levels are plummeting.

- See more at: http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/#sthash.2oBmiEIb.dpuf

For a student using insulin, diabetes must be managed 24/7, including the many hours spent at school, on field trips and in extra-curricular activities.

Some families can send their child with diabetes to school in the morning and feel confident that the school will be prepared to provide the diabetes care that meets their child's needs. Other families worry that their child won't have access to good diabetes management, that their child will be excluded from activities or have to take an exam when blood glucose levels are plummeting.

- See more at: http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/#sthash.2oBmiE And school administrators and nurses often have experience in helping kids with diabetes participate safely and successfully at school.

Working With the School

Most of the things you need to care for your child at home are needed at school, including a specific diabetes management plan, diabetes medications, and testing supplies.

At school, kids might need to:

check their blood sugar levels
take insulin or other diabetes medications
eat snacks when necessary
eat lunch at a certain time, with plenty of time to finish
have easy access to water and time to take bathroom breaks
get physical activity and participate in school events like field trips
recognize and get treatment for low blood sugar episodes

Diabetes management materials that need to go to school might include:

medications
testing supplies
snacks
a medical identification bracelet or necklace

You might arrange these items into packages for teachers, the school nurse, coaches, your child, and others.

And school administrators and nurses often have experience in helping kids with diabetes participate safely and successfully at school.

Working With the School

Most of the things you need to care for your child at home are needed at school, including a specific diabetes management plan, diabetes medications, and testing supplies.

At school, kids might need to:

check their blood sugar levels
take insulin or other diabetes medications
eat snacks when necessary
eat lunch at a certain time, with plenty of time to finish
have easy access to water and time to take bathroom breaks
get physical activity and participate in school events like field trips
recognize and get treatment for low blood sugar episodes

Diabetes management materials that need to go to school might include:

medications
testing supplies
snacks
a medical identification bracelet or necklace

You might arrange these items into packages for teachers, the school nurse, coaches, your child, and others

Seizures

What is the parent or legal guardian’s responsibility?

Notify the school that your student has seizures
Complete a Seizure Action Care Plan
If your child needs emergency seizure medication in school, please have the school contact a district Registered Nurse.
In case of an emergency, you may need to provide your home, work, cellular and/or contact numbers
Keep the emergency card current and immediately notify the school of any changes
Keep the school updated on any changes in seizure care of your child

What is the school’s responsibility?

Provide a safe environment for your student
Notify appropriate school personnel of your student’s seizures
Have an emergency plan for your student in case of a seizure at school
Call you if your student needs to go home
Call your designated emergency contact if you are not available
Notify you of special programs, such as field trips or class activities

How can the Registered Nurse help?

Review your student’s emergency plan and medications to be used at school
Make sure that your child and appropriately trained personnel know how to give the medications
Train appropriate school personnel on what to do if your student has a seizure
Inform school staff of an emergency plan for use when a nurse is not at school
Communicate with you and/or your student’s doctor when needed

Form to be completed for seizures that do not require medication to be administered at school:

Seizure Action Care Plan

Medication AdministrationTop of Page

All medication, whether over the counter or prescribed by a physician, must have a medication administration form signed and on file before we can administer medication to your child.

Once forms are signed, medication may be delivered by the parent/guardian or responsible adult only
Do not send medications into school with your child
Medication must be in the original package with a pharmacy label stating the students name, medication name, dose and route
Always let the school know if there has been a change in the medication type or dose
If pills require splitting please split them prior to bring them in
If medication is in the liquid form please bring the appropriate measuring tool

Medication Administration Form

Field Trip Letter Regarding Medication English Spanish

Authorization for Release of InformationTop of Page

Any exchange of information between your students health care provider and our staff must have an authorization to release information form on file. This allows the school nurse to communicate with your students health care provider to complete necessary forms for medication and create care plans.

General Exchange of Information

Kaiser

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