Health Forms
District Health Forms for Parents
Consent to Communicate with Medical Health Care Professional or Health Care Provider
There is a regulation regarding the consent to contact your child’s health care provider, if needed, in order to provide specific district health related services. In order to begin or continue to provide this service to your child, this consent must be on file. The regulation is provided in the form below. This consent is included in many of the PISD action plans and medication forms so it may not always be required as a separate document. Please sign and return this document to the school nurse, so we can provide continuity of care to your child. Consult your campus nurse if you are not sure.
Medication - Forms
- Medication Authorization Form- English
- Medication Authorization Form - Español
* A separate form is required for each medication. | Una forma separada se requiere para cada medicación.
Anaphylaxis - Forms
- An Allergy Disclosure form is to be completed at the time of initial registration and will be retained in the student record.
- Required* Anaphylaxis Action Plan - English | Español
- Statement Regarding Meal Substitutions or Modifications*
- Required Medication Request Form English | Español
*Doctor & Parent Must Sign
Diabetes - Forms
- Information Letter for Parents English | Español
- Required Diabetes Management Plan English | Español * (May be replaced by a similar plan from the physician. Parents must still complete pages 3-5.)
- Insulin Pump Physician Orders * (if applicable)
- Unlicensed Diabetes Care Assistant Consent English | Español * (If not included as part of the physician provided management plan.)
- Required Medication Request Form English | Español
- Continuous Glucose Monitor Use Agreement | Español (coming soon)
*Doctor and Parent must sign.
Seizure - Forms
- Information Letter for Parents - English | Español
- Required* Seizure Action Plan **This specific form from the Texas Education Agency is required for seizure management at school. No other forms will be accepted per Senate Bill (SB) 1506, 88th Texas Legislature, 2023.
- Parent Consent for Seizure Management Plan - English | Español
- Required Medication Request Form* English | Español
* Doctor & Parent Must Sign
Contact Us
District Health Office
1300 19th Street, Building A
Plano, TX 75074
(469) 752-2257
Fax (469) 752-5996