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    This list contains all of the required forms for a student diagnosed with an allergy to keep treatment medications in the school clinic A completed medication form is needed for each medication; so, print more than one copy of this form if your student will need more than one allergy medicine at school (Benadryl, EpiPen, etc).  There are both parent and doctor forms to be completed.
     
    Physician Documentation  (Physician form to complete and sign- 1 page)
     
    Allergy History/Assessment form  (Parent form to complete and sign- 2 pages)

     

    Medication Administration Form (Doctor's Order From)  (Doctor to complete and sign if prescription needed, and/or parent to complete and sign if over-the-counter medicine- 1 page. Each medicine will need a separate form.)
     
    Diet Modification Form- complete Part A or B and return or Fax