Health Forms:

Health Treatment Plans: 

Health treatment plans should be completed by the student's healthcare provider and parent annually. The appropriate forms and medication(s) can be delivered to the nurse one week prior to the beginning of the school year.  All medications must be delivered by the parent in the original and unopened packaging. Students are not permitted to transport medications to and from school.

Below are downloadable Health Treatment forms. All Health Treatment forms must include the Health Treatment Plan Authorization. (1st link below)

Health Treatment Authorization 

Asthma Action Plan

Seizure Treatment Plan

Tube Feeding Health Treatment Plan: Please complete all 3 forms listed

Health Treatment Authorization (Part 1)

Tube Feeding Health Treatment Plan (Part 2)

Authorization for Specific Medical Procedure (Part 3)

Virginia Diabetes Medical Management Plan

Cancer Health Treatment Plan

Authorization for Medication Administration

Allergy Action Plan: Please complete all 5 forms listed 

Allergy (Part 1)

Allergy (Part  2)

Allergy (Part 3)

Allergy (Part 4)

Allergy (Part 5)

Medical Release Form:

Medical Release Form


All current Health Forms can be found on Prince William County Public Schools site.