Medical Forms




Medical Forms - All Schools 
(click to download forms)
General Medication Form

             This form is for daily medication that must be taken during school hours. This form is also for medications that are kept in the nurses office but used only as needed. 
 
Medication Self-Administration Form
This form is to be used for self-medication needs pertaining to Epi-Pens, Inhalers, or Diabetic medications. If your physician has instructed your child on how to self-administer his/her own medication, New Jersey law permits that your child carry their medication on their person and self administer the prescribed medication as needed.  This form must be signed by the parent, the student, and the physician. Your child's school nurse must inspect the medication and have the completed form in order for your child to carry their medication. 

Note, New Jersey law does not permit students to carry and/or self-administer any other medications. All other medications must be kept in the Health Office and administered by the School Nurse.  
Asthma Action Plan
Asthma Treatment Plan

If your child has asthma, please download the Asthma Action & Treatment Plans to be completed by your physician. These two forms address medication needs, self administration, if appropriate for your child, and acts as a release for exchange of information between the school nurse and your child's health care provider. This is especially important in the event that your child is having increased asthma related symptoms. 
Seizure Action Plan

If your child is being treated for seizure disorders, please have your child's health care provider complete the action plan. This action plan provides the foundation for ensuring the best possible safety and treatment interventions are is in place for your child during school hours or school sponsored events.