Health Care Plans & Forms
RCW 28A.210 requires that students with life-threatening conditions must have physician orders and a health care plan before attending school. This information may be shared with school district staff that have a "need to know," in order to provide a healthy, safe environment.
Click a link below to view or download a file.
- Severe Anaphylaxis Care Plan and Medication Orders- HS-634
- Allergy Information- HS-630
- Concussion Pilot Form-HS 598
- Activity Restrictions Primary HS 112A
- Activity Restrictions Secondary HS 112B
- Authorization for Release of Information HS 210A
- Authorization for Exchange of Information- HS 210
- Medication Request Form- HS-300A
- Self Carry Medication Request Form- HS-300B
- Seizure VNS orders- HS 714
- Seizure Combined Health Care Plan-HS 713
- HS-555 Asthma Health Care Plan
- Dietary Accommodations 2022