Medical Forms

Health Care Plans

Students with one or more of the following medical conditions or any medical condition that may require intervention by staff during the school day require an up to date health care plan each year. If your student may need epinephrine, allergy, asthma, or seizure medications the medication permission is within the health care packets and you do not need to fill out the Prescription Medication Authorization form in addition. For diabetic supplies and all other prescription medications you will need a Prescription Authorization Form signed by your students health care provider for each medication.

 

Students may be allowed to assume responsibility for carrying and administering their own medications such as asthma medication, epinephrine, or diabetes medication provided that self-administration is approved in writing by the prescribing health care provider, the parent or guardian, and the school nurse approves. 

 


 

Additional Medication Forms

 

Other Forms/Policies

 

If you have any questions or concerns please contact:

 

Natasha Breakall RN, BSN

School Nurse

North Salt Lake Spectrum Academy

801-936-0318 x 7012 

natasha.breakall@spectrumcharter.org

 

Anna M Deltejo RN, BSN

School Nurse

Pleasant Grove Spectrum Academy

anna.deltejo@spectrumcharter.org

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