The following form should be completed by you and your child’s health care provider for any medications/medical treatments not covered by a Pleasanton ISD action plan. This could include medications for ADD/ADHD, over-the-counter medications, g-tube feedings, catheterization, etc.
This form will allow us to administer a medication and/or provide a medical treatment that your child requires at school. Your child’s health care provider will be able to share pertinent information with the clinic staff to better manage your child’s health at school. After your child’s health care provider completes the form, sign the bottom portion, and return to the school clinic. We will accept alternate forms from your child’s physician if they prefer to use their own. Please make sure that their forms include all of the same information as the forms Pleasanton ISD has provided. Please bring your child’s current medications and/or supplies with the completed forms to the clinic office. A new form must be completed each school year.