Student Heath Condition Portal

Please print and complete the applicable form(s).  Return the form(s) to your child's school office or scan and email the completed forms to hservices@mesd.k12.or.us

My child's inhaler will be kept in the health room:

• Child's Medical History: Asthma
• Authorization for Medication Administration by School Personnel

My child is able to carry and use their inhaler without help:

• Child's Medical History: Asthma
• Self-Medication Agreement

My child has asthma but will NOT have medication(s) for this health condition at school:

• Student Medical History: Asthma

Please print and complete the applicable form(s).  Return the form(s) to your child's school office or scan and email the completed forms to hservices@mesd.k12.or.us

My child will need supervision/assistance with their diabetes (counting carbs, giving insulin, etc.):

• Child's Medical History: Diabetes
• Authorization to Exchange Health Information
• Parent Authorization for Specialized Health Care
• Diabetes Treatment Orders - Provide a copy of medical orders to school office or email them to hservices@mesd.k12.or.us
• Authorization for Medication Administration by School Personnel

My child will be able to manage their diabetes independently (no staff supervision will be given except to administer glucagon as ordered):

• Child's Medical History: Diabetes
• Authorization to Exchange Health Information
• Parent Authorization for Specialized Health Care
• Self-Manager Agreement for Students with Diabetes
• Diabetes Treatment Orders - Provide a copy of medical orders to school office or email them to hservices@mesd.k12.or.us
• Authorization for Medication Administration by School Personnel

Please print and complete the applicable form(s).  Return the form(s) to your child's school office or scan and email the completed forms to hservices@mesd.k12.or.us

My child has a seizure disorder:

• Child's Medical History: Seizure
• Authorization for Medication Administration by School Personnel - only complete if your child has seizure rescue medication at school
• If you have orders or written directions from your child's physician pertaining to activity restriction or VNS use, please provide a copy of those medical orders to the school office or email them to hservices@mesd.k12.or.us

Please print and complete the applicable form(s).  Return the form(s) to your child's school office or scan and email the completed forms to hservices@mesd.k12.or.us

My child’s emergency EpiPen/epinephrine will be kept in the health room:

• Child's Medical History: Severe Allergic Reaction (SAR)
• Parent Authorization for Specialized Health Care (Administration of epinephrine for SAR)
• Authorization for Medication Administration by School Personnel - only complete if your child also has an antihistamine at school in addition to epinephrine

My child is able to carry and use an EpiPen/epinephrine without help:

• Child's Medical History: Severe Allergic Reaction (SAR)
• Parent Authorization for Specialized Health Care (Administration of epinephrine for SAR)

Please print and complete the applicable form(s).  Return the form(s) to your child's school office or scan and email the completed forms to hservices@mesd.k12.or.us

My child has a health condition:

• Child's Medical History: Other
• Authorization for Medication Administration by School Personnel - only complete if your child has medication at school
• Self Medication Agreement - only complete if your child will be carrying and managing their medication on their own without school staff supervision