Complete this form if your child needs a medication given during school hours.  More information about medication administration at school can be found under Stewartville Public Schools Medication Policy 516 or by contacting the Licensed School Nurse.
Medication Authorization Form

This form gives the school authorizations to administer epinephrine (e.g. EpiPen, Auvi-Q) to a child during an anaphylactic reaction (life-threatening allergic reaction) during the school day.
Anaphylaxis Emergency Plan Form

Asthma action plans need to be completed for students with asthma.  Asthma action plans can be requested from your Health Care Provider.  It is electronically signed by your child’s physician and is valid for a year from the signature date.
Asthma Action Plan Form

This form should be completed for students that have a seizure disorder.  If there is a seizure medication that will be kept at school, you will need a physician’s signature.
Seizure Emergency Care Form

The Diabetes Medical Management Form or a written order signed by a physician for medications (e.g. insulin, glucagon) is required.  Parents are responsible to bring all diabetic supplies (e.g. test strips, meter, insulin, needles, syringe, glucagon, snacks, glucose tabs, ketone strips) to the health office prior to the beginning of the school year.
Diabetes Medical Management Form

This form should be completed for students that have Long QT Syndrome.  A Health Care Providers signature is required.
Long QT Syndrome Emergency Form

This form needs to be completed by your child’s physician.  It gives Taher, Stewartville Public School meal provider, direction on appropriate meal substitutions for a child’s special diet (e.g. food allergies that result in severe, life-threatening (anaphylactic reactions). If your child will be eating school meals and/or taking a beverage and will be needing substitutions due to food intolerance or allergy, please contact Christie Mabe with Taher at 507-533-1604.
Special Diet Statement Form