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Forms

Explanation of Forms
In the Forms folder on the left is a list of forms which are necessary if your child has received an ASTHMA diagnosis, has FOOD ALLERGIES, has an EPI-PEN or needs to take medications while at school. Call the school nurse at 789-4478 for more information. 

Asthma Treatment Plan -This form is to be completed by the physician for all asthma medication use in school. This is a state requirement for all students receiving an ASTHMA diagnosis.

Diabetes - please call (908) 789-4478 to speak with the school nurse.

Emergency Health Care Plan for Designee - This form is to be completed by the parents and school nurse. It describes the signs and symptoms that the child manifested during a severe allergic reaction and the actions to be taken by the designee in the absence of the school nurse.

Epi-Pen Parent Consent - This form is signed by the parent giving the school nurse permission to choose and train a school designee to administer epinephrine in the absence of the school nurse.

Food Allergy Action Plan - This form is filled out by the child's physician describing symptoms and treatment of food allergy indicating when an antihystamine or epinephrine medication is to be used by the school nurse.

Medication Authorization Form - This form is filled out by the physician and parent. It must be completed by the physician for any over the counter or prescription medication that needs to be taken during school hours.