Medical Condition Individualized Healthcare Plan SECTION III: Brief description of medical condition: circumstances that may lead to potential emergency: CLASSROOM: PHYSICAL EDUCATION: FIELD TRIPS: BUS TRANSPORTATION: EMERGENCY DRILLS AND SCHOOL CRISIS EVENTS Crisis Follow School Safety Plan. After School Care: □During School Nurse will secure medications in □ accordance with school safety plan In event of building evacuation, School Nurse or □ Extracurricular Activity: Medication Assistant will evacuate with medications. In event of building evacuation, School Nurse Location is: □ Student requires assistance to evacuate building? □ No Yes □ □ If describe: “yes”, Written Notes/Addendum to Plan of Care
Medical Condition Individualized Healthcare Plan SECTION III: Brief description of medical condition: circumstances that may lead to potential emergency: CLASSROOM: PHYSICAL EDUCATION: FIELD TRIPS: BUS TRANSPORTATION: EMERGENCY DRILLS AND SCHOOL CRISIS EVENTS □During Crisis Follow School Safety Plan. □ School Nurse will secure medications in accordance with school safety plan □ In event of building evacuation, School Nurse or Medication Assistant will evacuate with medications. □ In event of building evacuation, School Nurse Location is: □ Student requires assistance to evacuate building? □ No □ Yes If “yes”, describe: After School Care: Extracurricular Activity: Written Notes/Addendum to Plan of Care
IHP%20General%20Packet%207.29.16.docx