Required for any student with life-threatening allergies to foods, medications, insects, etc. that requires prompt action and potentially the use of an automated epinephrine injector. Students are not permitted to carry or self-administer Epipens without these forms completed by the healthcare provider and signed by a parent/guardian. 

Required for any student with asthma that requires the use of an inhaler and/or nebulizer. Students are not permitted to carry or self-administer inhalers without these forms completed by the healthcare provider and signed by a parent/guardian. 

Required for any student with diabetes to direct actions for management of their condition at school. Note: if the student's diabetes doctor provides their own school action plan forms, those are acceptable in lieu of the DMMP forms posted here.

Required for any student needing medications during school hours (this includes asthma inhalers and Epipens for life-threatening allergies). Must be completed by the child's healthcare provider and signed by a parent/guardian. Medications cannot be taken at school without this form completed. Note: a separate form must be completed for each medication ordered — single forms with multiple medications listed are not acceptable and will be returned for correction.

Required for all new students who need a physical that is not related to sports.

Complete and return this form to the school nurse at the start of school.

Required for any student who has a seizure disorder, including epilepsy, to direct actions for management of their condition at school. Note: any rescue medications ordered in the plan must be turned in with the forms.

Required for any student to participate in school sports. 

Parent/Guardian and student complete and sign the History Form (pages 1 & 2) and the Athletes With Disabilities Form (page 3, if applicable). These forms should be maintained by the healthcare provider completing the physical exam (medical home). They should not be shared with schools.

Physician/APN/PA to review the History Form, and complete the Physical Examination Form (page 4) and Medical Eligibility Form (page 5). The Physical Examination Form should be maintained by the healthcare provider completing the physical exam (medical home). It should not be shared with schools. The Medical Eligibility Form is the only documentation required to be submitted to the school.