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Medical Forms

In order to ensure the health and safety of children requiring any medication during the school day, GLOBE has established a series of procedures for medical care, which you may read about in our GLOBE Family Handbook
Below are some frequently requested medical forms that should be printed, completed, and returned to the school nurse/admin.
  • Physician’s Request for Administration of Medication Form must be signed by the child’s physician and parent/guardian. The medication form should be taken to the child’s licensed prescriber (doctor, nurse practitioner) for completion and returned to the school nurse/admin. This order must be renewed as needed and at the beginning of each academic year. This form is necessary for all medications including over the counter and prescription.
  • The Food Allergy Action Plan. The school nurse/administration, in conjunction with the student’s parent(s)/guardian(s) and the primary care provider/allergist, will prepare an Allergy Action Plan/Individual Health Care Plan for any student with a life-threatening allergy. The plans will be reviewed by the school nurse/admin, the student’s parent(s)/guardian(s), and primary care provider and/or the student’s allergist, and signed off by the child’s physician indicating that he/she deems it to be adequate. Multiple copies of the Allergy Action Plan/Individual Health Care Plan will be kept at the school for quick access in the clinic, main office, the student’s homeroom, and in the homeroom teacher’s emergency binder/backpack. (en español)
  • Asthma Action Plan.