Imagine School at Land O' Lakes

Severe Allergy/Seizure/Diabetes Medical Management Plan Form

Authorization for Medical Administration Form

Clinic Assistant

Your child's health is important to us!

ISLOL Medication Guidelines 

Imagine School Land O' Lakes  follows the Pasco County Schools Guidelines for Administering Medication at School.    

Dear Parent or Guardian, 

According to District School Board of Pasco County Policy 5335, students who receive medication, health procedures or have special dietary needs (e.g. Diabetes Management, Diastat, Asthma Inhaler, EpiPen, Pancreatic Enzyme Supplement) at school shall provide annual parental and healthcare provider authorization for the administration of medications and procedures.

If your child plans to carry his/her own supplies and/or perform any of the above medical procedures independently and without supervision during the next school year:

• Please return the Authorization to Carry and Self Administer Diabetes Medication/Procedure, Asthma Inhaler, EpiPen, Pancreatic Enzyme Supplement form (available on the district website) signed by physician, parent and student on or before the first day of school.
  
• Please make sure your child carries all necessary supplies (Diabetes equipment or medication, Inhaler, Epipen, and/or Pancreatic enzyme supplement) at all times.
  

If your child may/will require assistance with administration of medication and/or procedures at any time during the next school year:

• Depending on your child’s condition, please return either the Severe Allergy (Anaphylaxis) or Seizure or Diabetes Medical Management Plan form (found below) completed and signed by physician and parent on or before the first day of school.
  
• Please return the Authorization for Medication Administration form (available on the district website) for any medication that will need to be administered for your child on or before the first day of school. This form should be completed and signed by parent.
  
• Please provide the school clinic with all necessary supplies. Remember that medication must be brought to school by the parent / guardian (e.g. Insulin, Glucagon, Diastat, Inhaler, Epipen, etc.).
  

If your child may/will require assistance with special dietary needs during the next school year:

• Please submit completed FNS Request and/or Severe Allergy (Anaphylaxis) Medical Management Plan forms. The FNS Request Form will be reviewed/evaluated by the Food & Nutrition Services District Office on a case-by-case basis. Since school sites are not allergen free facilities, it may be beneficial to send a meal from home for the first few weeks of school.
  

While not all students’ requests will be accommodated, our online menus identify common allergens and carbohydrate/nutrient information to assist you and your child in navigating their meal options. You can access this helpful tool online at http://pasco.nutrislice.com or download the mobile app on your smartphone or tablet.

Diabetes Self-Carry and Medicine Administration Form

Inhaler/EPI Pen Self-Carry Authorization Form

NOTES FROM THE CLINIC

Marisol Connell