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Asthma Action Plan
The Asthma Action Plan allows parents and students to work with medical providers to create a plan for management of asthma and administration of medication while students are at school. This form must be completed by a medical provider and signed by a parent or guardian.
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Diabetes Management Plan
The Diabetes Management Plan must be completed by a licensed medical provider. This form includes information about the treatment plan, medication administration, and emergency plan for students diagnosed with diabetes.
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Emergency Action Plan - Seizures
The Emergency Action Plan for seizures is a form that parents can complete to give school staff information about a student's history of seizures, medications, and how to respond to a seizure.
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Emergency Action Plan - Severe Allergy
The Emergency Action Plan for severe allergy is a form that parents can complete to give school staff information about a student's history of allergic reactions, specific list of allergens, plans to protect the student from allergens at school, and how to respond to an allergic reaction.
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Medication Authorization for Students
The Medication Authorization form should be completed by a licensed medical provider and signed by a parent or guardian. This completed form is required for any prescription or over the counter medications to be administered to students by school staff.
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NC Health Transmittal Form
The North Carolina Health Transmittal form must be completed by a licensed medical provider and is required for all students enrolling in a NC public school for the first time.
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NC Medical Statement Diet Order
The Medical Statement for Students with Unique Mealtime Needs for School Meals helps schools provide meal modifications for students who require them. Schools cannot change food textures, make food substitutions, or alter a student’s diet at school without proper documentation from the healthcare providers. Completion of all items will allow your child’s school to create a plan with you for providing safe, appropriate meals and snacks to your child while at school.
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NCHSAA Gfeller Waller - Return to Learn/Play Forms
The purpose of the Gfeller-Waller Concussion Policy is to protect student-athletes in North Carolina. If any student athlete is diagnosed with a concussion, these forms must be completed by a licensed healthcare provider.
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Overnight Travel Medical Packet - English
Please follow the guidelines below for your child if he/she needs medicine during the overnight field trip. Please note the KCS medication policy is the same on any field trip, including overnight, as it is during regular school hours. If you have any questions or concerns, please contact your School Nurse.
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Overnight Travel Medical Packet - Spanish
Si su hijo/a necesitará medicamentos durante el viaje escolar de varios días, por favor siga los procedimientos a continuación. Tenga en cuenta que las normas para medicamentos de KCS son las mismas para todos los viajes escolares, incluso los viajes de varios días; ya que el viaje está llevándose a cabo durante el horario escolar. Si tiene cualquier pregunta o inquietud, comuníquese con la enfermera de la escuela.
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Return to Learn Form
The Return to Learn form should be complete by a licensed medical provider for any student who has been diagnosed with a concussion. This form describes what accommodations are needed in the school learning environment when a student has been diagnosed with a concussion.
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Specialized Healthcare Procedure Order Form
The Specialized Healthcare Procedure form must be completed by a licensed medical provider and signed by a parent or guardian. This form should be used for healthcare procedures that will be performed at school (examples: urinary catheterization, Gtube care and feedings, Vagal Nerve Stimulator, ostomy care). Please check with your student's school nurse if you are unsure of whether this is the form that your student will need for a procedure to be performed by school staff.
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Standards of Care for Diabetes Management in the School Setting
This document is meant to work in conjunction with the student’s Diabetes Management Plan (DMP) and orders to keep the student healthy and safe at school.
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Student Health Information
Parents are responsible for providing the school with any medication or medical equipment that is needed to care for their child during the school day. If there are any changes to your child's health condition during the school year please inform the school nurse ASAP.
