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Medication and Other Health Forms

  • At the start of the school year, please list any medical concerns on the Emergency Card that is to be returned to school.
  • If listing Diabetes, Seizures, Food Allergy, Bee Allergy, Asthma, or Celiac Disease, please download the appropriate form under "Action Plans" on this Website.
  • If an additional Medical Action Plan is needed for your students, please contact the health care staff in your school clinic.
  • Individual Health Care Plans may also be developed for other medical conditions if needed by the RN in your district.
  • Please let the office know if you need a Health Care Plan for your student or if a meeting is required to review the student's health condition from a previous school year.


This information is needed from you so that we can follow the steps necessary if a medical emergency arises regarding that condition.


Please indicate if an inhaler is self-carried by the student and where it will be located during the school day.


If your student is a diabetic, please let us know if he/she is on insulin at school or will have Glucagon.


Medication forms for prescription/nonprescription medicine may be obtained from the school office. There are medication forms for several districts available on the right.


Your doctor/physician may fax any medical/medication forms to the school directly. This information will be used to provide health information to staff members who have direct contact with your student to maintain his/her health and safety during this school year.


Please see the link below, and return the bottom portion to the health clinic staff if needed.
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124 W. Washington St.    |     Medina, OH 44256    |     Phone: 330.723.6393    |     Fax: 330.723.0573    
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