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Lafayette School Corporation

2300 Cason Street, Lafayette, IN 47904
(765) 771-6049(765) 771-6000
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      • Head Injury/Concussion Information
      • Health Information and Resources
      • Lafayette School Corporation Nursing Staff
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      • Mission Statement
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      • IT Resources Available to Staff
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      • SharpSchool Resources
      • Adding EMail to Phone or Tablet
    • Transportation
      • Bus Stop Information
      • Transportation Staff
      • Bus Safety and Conduct
      • Closings and Delays
      • How to become a Bus Driver
      • Frequently Asked Questions
      • GLASS Transportation
      • Foster Care Transportation Request
    • Special Education (G.L.A.S.S)
  • Employment
    • AppliTrack – For New Applicants
    • Safe Hiring General Applications
    • Licensing and License Renewal
    • Substitute Teachers
  • Community
    • Community Resources
    • Facility Usage
    • Learning in Lafayette
    • Media Resources
    • Public School Foundation
    • Volunteers
    • Wall of Fame
  • Calendar
    • 2017-18 pdf calendar
    • Oakland pdf Calendar
    • Upcoming Events
    • 2018-19 Calendar
  • Home
  • Corporation
    • About Us
      • Schools
      • Electronic Backpack
      • Directories
    • Board of Trustees
      • Members
      • Meetings, Agendas and Minutes
      • BoardBook Login
      • Policies
      • Title IX
    • Executive Staff
      • Superintendent
      • Executive Staff Directory
  • Schools
  • Parents
    • Informational Resources
      • Bus Information
      • Transfer Policies
      • It's My Closet
      • College and Career
      • Student Handbooks
      • School Supply Lists
      • Calendar
      • Health Services
      • Homeless Students
      • Kindergarten Round-Up
    • Instructional Resources
      • PowerSchool Mobile app
      • Renaissance Place Home Connect
      • Math Resources
      • Federal Programs
    • Electronic Backpack
    • SecureVolunteer
    • Quicklinks
      • PowerSchool
      • Food Service
      • Calendar
    • Title IX
    • Online Student Registration
  • Staff
    • Quicklinks
    • PowerSchool for Teachers
    • PowerSchool for Administrators
    • PowerSchool for Substitute Teachers
    • Absence Management (AESOP)
    • Office365 Online
    • School Messenger
    • Work Order System
    • Broncho NextGen
    • Tippecanoe County Public Library Digital Contents
  • Departments
    • Health Services
      • Health Services Guidelines
      • Immunization Information
      • Medication Administration Information
      • Severe Allergy Information
      • Vision and Hearing Screening
      • Health Forms
      • Head Injury/Concussion Information
      • Health Information and Resources
      • Lafayette School Corporation Nursing Staff
    • Business Office
      • Mission/Vision/Motto
      • Public Forms and Information
    • Curriculum and Instruction
      • Elementary
      • Secondary
      • Federal Programs
      • High Ability Program
    • Food Services
      • Online Payments
      • Free and Reduced Online Application
    • Personnel Department
      • Contracts
      • LSC Employee Benefits
      • Health Clinic
      • Personnel Calendar
      • Staff Wellness
    • Facilities
      • About Us
      • Custodial
      • Grounds
      • Maintenance
      • Notifications
      • Resources
      • Facilities Calendar
      • Work Order System
      • Facilities News
      • Projects Photo Gallery
    • Technology
      • Mission Statement
      • IT Help Desk/Work Order System
      • Staff Listing by Person/Responsibility
      • IT Knowledgebase
      • IT Resources Available to Staff
      • IT Change Management Calendar
      • MS Surface Videos
      • SharpSchool Resources
      • Adding EMail to Phone or Tablet
    • Transportation
      • Bus Stop Information
      • Transportation Staff
      • Bus Safety and Conduct
      • Closings and Delays
      • How to become a Bus Driver
      • Frequently Asked Questions
      • GLASS Transportation
      • Foster Care Transportation Request
    • Special Education (G.L.A.S.S)
  • Employment
    • AppliTrack – For New Applicants
    • Safe Hiring General Applications
    • Licensing and License Renewal
    • Substitute Teachers
  • Community
    • Community Resources
    • Facility Usage
    • Learning in Lafayette
    • Media Resources
    • Public School Foundation
    • Volunteers
    • Wall of Fame
  • Calendar
    • 2017-18 pdf calendar
    • Oakland pdf Calendar
    • Upcoming Events
    • 2018-19 Calendar

Health Forms

Lafayette School Corporation » Departments »  Health Services » Health Forms
Health Forms/
c
Health Services Guidelines
Immunization Information
Medication Administration Information
Severe Allergy Information
Vision and Hearing Screening
Health Forms
Head Injury/Concussion Information
Health Information and Resources
Lafayette School Corporation Nursing Staff
These forms can be printed and taken to your student's doctor. Please return the completed forms to your school nurse.

ASTHMA
Asthma Management Plan and Authorization for Medication.pdf

ALLERGY
Allergy action plan from FAAN for physician and parent signature.pdf

DIABETES
LSC DMTP non pump student for the physicians to complete.pdf 

​LSC DMTP for pumper student for the physicians to complete.pdf

RELEASE OF HEALTH INFORMATION
​Mutual Release of Protected Health Info Authorization in English - 2010-11.pdf

​Mutual Release of Protected Health Info Authorization in Spanish  
2010-11.pdf


SEIZURES
Seizure Action plan from Epilepsy foundation 2009.pdf

RECTAL DIAZEPAM MEDICATION ORDERS IN SCHOOL (TO GO WITH SEIZURE hcp WITH RD).pdf

​

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Lafayette School Corporation

  • 2300 Cason Street, Lafayette, IN 47904
  • (765) 771-6049(765) 771-6000
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