Forms

Consent to Treat

These documents must be updated each school year.  They are provided electronically as a part of the online registration process for both existing students and new enrollments and should be completed prior to the start of the school year.  Students must have a consent to treat signed by a parent or guardian to be seen in the school nurse clinic. All students will be treated in the case of an emergency.

 

 – Consent to Treat Form

 – Consent to Treat (Spanish)

 – FTCSC Health Concerns Form

 

Medication Forms

Medication consent forms are necessary for any medication to be given by the school nurse during the school day.  A parent or legal guardian must complete the form for each medication and bring the medication to the school. The form will be kept on file in the school nurse clinic.  Prescription medications must be brought with the current pharmacy label attached. The nurse must follow the instructions on the prescription label. Over the counter medications must be in the original container.  The school nurse will follow instructions on the label unless otherwise instructed by a health care provider’s written order.

 

 – Medication Consent Form

 – Consent to Carry Emergency Medication Form

 

Emergency Action Plans

If you have indicated that your child has a chronic health condition on the Health Concerns form please have your health care provider fill out one of the following action plans and return to your school nurse.  These should be updated at the beginning of each school year.

 

Asthma Form

 – Asthma Action Plan

 

Seizure Forms

 – Seizure Action Plan

 – Diastat Care Plan

 

Life Threatening Food Allergy Packet Forms

 – FTCSC LTA Management

 – Eating and Feeding Evaluation Medical Order Form

 – FARE Emergency Action Plan

 – Parent and Student Responsibilities

 

Other Allergy Action Forms

 – Allergy Action Plan

 

Diabetes Form

 – Diabetes Action Plan