Seizure Action Plan (Medication Administration)

Information

 

 

If your child needs Seizure medications, your Healthcare Provider must fill out the Seizure Action Plan/Medication Administration "STATE" Form, sign & stamp.  Your Healthcare Provider is NOT required to fill out any other form for Seizure medication administration.

 

This form must also be signed by Parent/Guardian.

 

The Seizure Action Plan/Medication Administration Form enables the school nurse to assist your child should he/she have a seizure.

 

If your child does not need seizure medication, do not write on this form.  Please return to school nurse to be re-used or re-cycled.

 

The Seizure Action Plan/Medication Administration Form is valid for one school year, ONLY.  

 

 

 

Updated 2/9/2020