All students with a medical diagnosis of asthma should have an Asthma Action Plan and their emergency medication at school. Students who are able to “self-carry” their asthma inhaler must have documentation of this in the school office.

Please fill out the forms relating to asthma and have your child’s health care provider complete their portion. Return this to the school nurse on the first day of school.

It is highly recommended that students who self-carry their medication also keep and extra inhaler in the nurses office. Please contact your school nurse for further information.

  • Asthma Action Plan
  • Medication Authorization
  • Self Carry Form


Diabetes, both insulin-dependent and non-insulin-dependent, is becoming more common in the school setting. It is very important that we have a Diabetes Medical Management Plan at school for your child. Many times your child’s diabetes specialist will provide a plan for school utilizing their forms. If not, you may use the form below. Please return this information to the school nurse on the first day of school. Contact your school nurse for further information.

Diabetes Medical Management

Authorization to Self Carry Diabetes Medication and Supplies


Many students experience allergies. Food allergy is a common issue seen in the school and it can quickly turn into an emergency. If your child has a food allergy you will need to share this information with the school nurse and school personnel.

Avoiding the offensive food is our first line of treatment, but this is not always 100% successful. Because of this we must have and Emergency Plan in place and emergency medications available.

In this section you will find several forms that we need completed on your child.

  • Allergy History. This form tells us about your child's past experiences with food allergy and their awareness and ability to handle a reaction. We will need this form filled out once, and updated annually.
  • Allergy Action Plan. Completed by the parent/guardian and the child's health care provider.
  • Medication Authorization Form. Completed by the parent/guardian and the child's health care provider. All medication that we have at school for your child must have a completed Authorization Form.
  • Self Carry Form (if applicable). Intended for the older child to be able to "self-carry" his/her own medication if they are authorized by parent and health care provider, and have proven that they understand what the medication is and how/when to use it. This is especially important for those students who are part of extracurricular activities.

Please have the forms completed before school starts and bring them to school along with your child's medication on the first day of school. Current guidelines state that a person at risk for a severe reaction should have two doses of Epinephrine available. Please ask your health care provider to consider this when writing prescriptions for the medication.

GCSSD strives to recognize and treat allergic reactions quickly by training the school staff on the signs and symptoms of a reaction and keeping a stock supply of Epi-pens in each school (your child still needs his/her own supply). Additionally, as school nurses, we also talk to the students about severe allergies and anaphylaxis so that they are more aware of this condition. 

  • Food Allergy Emergency-Care Plan (with pictures)
  • Allergy Emergency Action Plan
  • Allergy History Form
  • Self Carry Form
  • Medication Authorization


If your child is allergic to insect bites/stings we need to have an allergy emergency plan in place at school. Please fill out the forms related to bite/sting allergy and the emergency medication that is used. Your child’s health care provider will need to complete and sign their portion of the forms. Students who “self-carry” their medication will need a self-carry form completed.

  • Allergy and Anaphylaxis Emergency Plan
  • Allergy History Form
  • Medication Authorization
  • Self Carry Form


There are many different types of seizures. If your child experiences seizures it is very important that we are able to recognize them and provide emergency treatment as prescribed. The following forms will help us develop a plan of care should a seizure occur during school activities. If an emergency medication is needed your child’s health care provider will have to complete their part of the form. Please contact your school nurse for further information.

  • Request for Medical Procedure (Diastat)
  • Questionnaire for Parent of a Student with Seizures
  • Seizure Action Plan


Medication shall be administered only when the student’s health requires that it be given during school hours. It is the parent/guardian’s responsibility to Bring the medication to school and REMOVE any unused medication when treatment is completed.


All prescription medication must be brought to school by the parent/guardian in the original container. The pharmacy label must include the following information:

  • Name of student
  • Prescription number
  • Name and dosage of the medication
  • Administration route or other directions
  • Date
  • Licensed Prescriber’s name
  • Pharmacy name, address, and phone number
  • Licensed prescriber and parent signature on the medication authorization form.

Over the Counter

All over the counter medications must be brought to school in the original manufacturer’s unopened, labeled container with the ingredients listed and the child’s name affixed to the container. The dosage MUST be appropriate for the child’s age.

The medication authorization form must be completed by the parent/ guardian.

We do not administer medications that contain Aspirin at school unless we have a health care providers orders/signature on the medication form.

If prescription medication must be given at school ask your pharmacist for a labeled bottle for school use at each refill.

We do not administer supplements, vitamins or NON-FDA approved medications at school

Medications must be kept locked in the office or secure with the teacher with the following exceptions: Pancreatic enzymes, Diabetes medications/supplies, Asthma rescue inhalers, and Epinephrine auto injectors. If your child is competent to carry these medications with them we must have parent and health care providers documented consent on the form below.

  • Medication Authorization
  • Self Carry Form Inhaler, Epi-Pen, and/or Pancreatic Enzymes
  • Self Carry Form Diabetes