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