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Information and Authorization Forms for Health Services.
Administrating Medication at School
- If possible, medication should be given at home
- If medications cannot be given at home, they will be administered in compliance with the Guidelines for Medication Administration in Kansas Schools and the Kansas Nurse Practice Act.
- All school-administered medications must have the appropriate authorization forms completed by guardians and/or medical providers before they can be administered to students.
- All USD 497 medication forms can be found below.
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Allergy Intake Form
Complete this form if your student has severe allergies that require emergency medication.
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Child Health Assessment Form
All students under the age of 9 must have a health assessment completed to enroll in any Kansas school. If needed, have your healthcare provider complete this form and return it to the school nurse.
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Diabetes Intake Form
Complete this form if your student has been diagnosed with diabetes.
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Gastrostomy Tube Intake Form
Complete this form if your student has a gastrostomy tube (G-tube).
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Physician's Order for Specialized Feedings
Have this form completed by your student's healthcare provider if your student needs a G-tube feeding at school.
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Kansas Asthma Action Plan
Complete this form with your student's primary care provider if your student has been diagnosed with any form of asthma.
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Over-the-Counter Medication Administration Form
Complete this form if your student will need over-the-counter medication at school. Only 10 doses may be given then a physician's note will be required according to the Guidelines for Medication Administration in Kansas Schools.
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Prescription Medication Form
Complete this form if your student needs prescription medication administered at school.
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Self Administration Medication Form
Complete this form if your student carries either over-the-counter or prescription medication and self-administers as needed.
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Seizure Intake Form
Complete this form if your student has had seizure activity in the past.
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Plan de Manejo Médico de la Diabetes (Diabetes Intake Form)
Complete este formulario si su estudiante tiene diabetes.
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Historial de alergias graves y formulario de admisión (Allergy Intake Form)
Complete este formulario si su estudiante tiene alergias graves que requieren medicamentos de emergencia.