Action Plan Forms

• Asthma Action Plan Form: To be completed for students with Asthma. To be accompanied by the
• Authorization for the Administration of Medication Form (e.g. inhaler).
• Food Allergy Action Plan Form: To be completed for students with severe food allergies. To be accompanied by Authorization for the Administration of Medication Form (e.g. EpiPen).
• Seizure Action Plan Form: To be completed for students with a seizure disorder. To be accompanied by
• Authorization for the Administration of Medication Form, if emergency medication prescribed (e.g. Diastat).
• Diabetes Medical Management Plan: This plan should be completed by the student's personal diabetes health care team. To be accompanied by Authorization for the Administration of Medication Form (e.g. Insulin, Glucagon).