Fort Wayne Community Schools Plan Permits
The following forms are available for you to print and complete. In addition to parent input, some of the individual health care plans require completion by, and a signature from, a physician.
Contact your School Nurse if you have questions or concerns. Return the completed care plans to your school nurse as soon as possible.
The parent is responsible for informing the school of medical care that is needed and for completing the care plans.
Licensed health care providers’ orders are required for specialized health services such as Epi-pen injection, self administration of medications during school, blood glucose monitoring (insulin administration), gastrostomy tube feedings, clean intermittent catheterizations, nebulizer treatments, food allergies, etc.
Forms Available in Different Languages
English
- Allergic Reaction Parent-Physician Info 2022-23
- Asthma Parent-Physician Info 2022-23
- Administration of Medication Permit 2022-23
- Self Administer Medication Permit 2022-23
- Administration of Herbal Supplements at School, Authorization
- Consent for Release of Information 2022-23
- Diabetes Medical Management Plan 2022-23
- Diabetes Medical Management Plan Pump Supplement 2022-23
- Diabetes Supply List Needed for School
- Nutrition Services Physician Letter 2022-23
- Guidelines for Accommodating Children with Special Dietary Needs
- Personal Health History 2022-23
- Immunization History
- School Dental Examination
- Seizures Parent-Physician Info 2022-23
- School Entry Physical Exam
- FWCS Physical Packet 2022-23
- Concussion Fact Sheet for Athletes
- Concussion Fact Sheet for Parents
- Concussion and SCA Acknowledgement Form
- Concussion Health Care Provider Return to Play Form
- Sudden Cardiac Arrest (SCA) Fact Sheet for Student Athletes
- Sudden Cardiac Arrest (SCA) Fact Sheet for Parents
- Flu Consent Form 2022-23
Spanish
- Reacción alérgica Información para padres y médicos 2022-23
- Asma Información para padres y médicos 2022-23
- Autorización para el suministro de medicacion en las escuela 2022-23
- Permiso para llevar medicamentos de emergencia 2022-23
- Autorización de suplementos herbales
- Consentimiento para divulgar información médica 2022-23
- Plan de control médico de la diabetes 2022-23
- Aviso de Vacunacion Para Todos los Estudiantes 2022
- Nutrition Services Physician Letter 2022-23
- Examen dental de la escuela
- CONVULSIÓN Información para padres y médicos 2022-23
- Expediente físico y de salud del estudiante
- Historial de Salud 2022-23
- Registro de vacunación
- Suministro de medicación en la escuela (Guía para los padres)
- Formulario De Autorizacion 2022-23
Burmese
- Administration of Medication at School, Procedure in Burmese
- Asthma Parent Physician Info
- Health History in Burmese 2022-23
- Immunization History in Burmese
- Notice of Immunization for all Students Enrolling in School
- School Dental Examination in Burmese
- Student Physical Form
- Nutrition Services Letter