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School Nurse Documents

You will find PDF Care Plan Documents here.

Display:

21 Surprising facts about headlice
 Last Updated Date: 03-27-2023

Head Lice

Adrenal insufficiency disease IHP
 Last Updated Date: 06-28-2024

Any allergy or anaphylaxis reaction needs this form filled out by doctor.

Asthma Action Care Plan
 Last Updated Date: 08-28-2024

Asthma Spanish form
 Last Updated Date: 02-06-2025

Asthma fillable Spanish Form

Concussion checklist
 Last Updated Date: 08-12-2024

Head injury checklist

concussion- head injury flowchart
 Last Updated Date: 08-12-2024

Diabetes - Baqsimi administration
 Last Updated Date: 03-27-2023

How to administer Baqsimi or powder glucagon.

Diabetes standard of care for students
 Last Updated Date: 05-17-2024

Diabetic Classroom Tips
 Last Updated Date: 03-27-2023

Field trips

Diabetic classroom tips
 Last Updated Date: 03-27-2023

Snack kit ideas

Diabetic classroom tips
 Last Updated Date: 03-27-2023

School Personnel responsibility

Hypo-Hyper glycemia signs and symptoms.

First Aid Guidelines
 Last Updated Date: 03-27-2023

First aid Quick Guide

Flu vs Cold
 Last Updated Date: 03-29-2023

signs and symptoms of the flu vs the common cold.

Health Exclusions
 Last Updated Date: 03-27-2023

Reasons to exclude students from school Quick reference.

I need to stay home if...
 Last Updated Date: 03-27-2023

When to send your child to school or not.

Immunization Exemptions
 Last Updated Date: 10-13-2023

This link will take you to the StateID Website.  You will need to create an account and login to Utahid.  If they have any state assistance, or state job, etc. they may already have an account.  You will still have to complete the module to create an exemption for the child wishing to have immunizations exempt. This can be done for Preschool, Kindergarten - 6th grade and 7th-12th. 

Medication Authorization
 Last Updated Date: 03-27-2023

Students taking medication at school must have a form signed by the doctor if they are under 6th grade.

Medication Calendar
 Last Updated Date: 03-27-2023

Medication Error report form
 Last Updated Date: 03-27-2023

If an error occurred please fill this form out.

Seizure Action Plan - IHP
 Last Updated Date: 04-26-2024

Individualized health care plan. Emergency action plan

Seizure medical order
 Last Updated Date: 04-26-2024

Seizure medication management order (SMMO)

Seizure observation record
 Last Updated Date: 03-27-2023

Recording a seizure in your classroom. tips and tricks and record to record on.

Signs of Hyper/Hypoglycemia
 Last Updated Date: 03-27-2023

Quick reference of signs and symptoms of Hyperglycemia and hypoglycemia.

Special meal request form
 Last Updated Date: 03-27-2023

If your child needs special accommodations for lunch or breakfast. complete this form

Vision Opt out form
 Last Updated Date: 03-27-2023

Form to opt out of routine yearly vision screenings.

Vision Symptoms questionnaire
 Last Updated Date: 03-27-2023

If you suspect a vision problem. Please fill this out and notify your school nurse.

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