Please read the information below and then email any necessary forms as attachments to Health Services with a subject line as follows: Health Forms – Last Name, First Name (for example: Health Forms – Doe, Susie)


Severe Allergy or Other Medical Management Concerns

CHA Health Services is able to support your child if he/she has a special medical condition that requires services during the school day, whether on a regular or as needed basis.

New doctor orders will need to be submitted before August 10. If your child has a severe allergy or medical concern, you must contact the school nurse so teachers can be informed before school begins. Some forms require a physician’s signature.

If your student has an emergency action plan on file with Health Services due to severe allergies or medical concerns, please be sure to communicate any changes or updates for next year. For more specifics, review the Severe Allergy/Medical Concern Resource Guide.

Severe allergy forms that must be resubmitted annually:

  • Emergency Allergy Action Plan & Treatment Authorization
  • Medication Authorization Form (Not required for emergency medications that are listed in Action Plan)
  • Inhaler/Epi-Pen Self-Administration Permission

Severe allergy forms needed once per enrollment (unless your child has a change in his/her medical condition):

  • Severe Allergy or Medical Concern History Form
  • Individual Health Care Plan

Other medical management forms (resubmitted annually):

  • Asthma Action Plan & Self Administration Permission Form
  • Diabetic Medical Management Plan (DMMP)
  • Seizure Plan

Find links to all forms on the main Health Services page. You may wish to print this page out so you know which forms are needed for your student.

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