Individual Health Care Plan

As per DFE guidance, we are required to gather all necessary information relating to students' medical needs. This allows us to make all staff aware of any medical requirements or allergies and the best course of action, for your child, in case of an emergency.

If your child has any medical conditions, needs or requirements, please fill out this form, in as much detail as possible.

Where a section is marked with an *, it is a mandatory section and must be filled in. You will not be able to continue to the next step or submit this form if these sections have not been filled in.

Student's Full Name* Student's Date of Birth* Home Address* Post Code*

Medical Conditions

Please list all your child's medical conditions and/or allergies. Please provide as much detail as possible of any known symptoms or triggers relating to your child's medical condition(s) or allergies. Please list all medication(s) your child requires for the above listed condition(s)/allergies. Include the name of the medication, required dosage, method of administration and at what time(s) this medication should be taken. Any medications required during the school day will also need to be noted in the Medical Consent section of this form. If your child is prescribed an allergy pen or asthma inhaler, please upload a copy of their emergency plan here. Please upload file here. No file chosen Please provide as much detail as possible of any known side effects or contra-indications .

Does your child successfully self-manage their medication?Yes (please provide more details)No

If yes, please provide further details regarding your child's self-management of their medication

Does your child require any additional daily care support to assist them with the above listed condition(s)?Yes (please provide more details)No

If yes, please provide further details regarding your child's daily care support needs

Does your child require any specific support for their social, emotional or mental health and wellbeing?Yes (please provide more details)No

If yes, please provide further details of your child's social, emotional or mental health and wellbeing needs

Emergency Procedures

In the event of a medical emergency for your child, please provide as much detail as possible of any actions that need to be taken:

Medical Consent

In order for medication (prescribed or otherwise) to be given at school, we must have written consent from parents and carers.

Please read the following information carefully and ensure that this section is filled out accurately.

1. Medication will not be accepted by the school unless this form is completed and signed by the parent or legal guardian of the child and that the administration of the medicine is agreed by the Headteacher.
2. This agreement is for the current school academic year only and unless notified, all medications and consent forms will be destroyed at the end of the school academic year. Please notify us by the last week of Term 6 if you still wish for us to hold the medication(s). Out of date medication will automatically be destroyed.
3. The Governors and Headteacher reserve the right to withdraw this service.
4. In the event of an emergency, details of any medication given or stored may be shared with emergency services or other professionals.
5. Please ensure all medications are clearly labelled indicating contents, dosage and child's name in FULL and is in the original packaging.
6. Medication will only be given in accordance with our Medication Policy.
Should your child require medication in school, unless it is a life-saving prescribed drug (i.e. diabetic pack, insulin, inhaler, EpiPen) all medicines must be kept in the medical room with this form.
Students are not allowed to carry any medications on their person unless authorised to do so or required to carry life-saving drugs.
Unless there are exceptional circumstances, paracetamol will not be given first thing in the morning (i.e. before 10:30 a.m.) so as to avoid overdose and will not be given after lunch (i.e. after 2:00 p.m.) for the same reason.
First aiders, upon consent from a parent or guardian, will only be able to administer a dose of paracetamol in accordance with the instructions on the packet. This is usually Under 11 years of age = 10ml liquid paracetamol, 12-15 year old = 1 paracetamol tablet and 16 years and over = 2 tablets.
Ibuprofen will only be given at break or lunch after a meal.
We are unable to administer more than that listed above or what is printed on the packet.

Please enter name of medications required during the school day (these are to be brought into school):

Please select one of the followingMedication is to be administered as and when it is requiredOngoing prescribed course of medication

Please provide as much information related to the course duration of the medication(s) Please provide as much detail as possible relating to the dosage of the medication(s) Please provide the date of which medication(s) were prescribed Please provide as much detail as possible relating the times that the medication(s) are to be administered

Please tick where appropriateThe above listed medication has been purchased by myself.The above listed medication has been prescribed by the family or hospital doctor.

Please tick where appropriate:*This medication is a prescribed regular drug and we do not require calls for consent. This medication is to be administered as per the dosage and timings provided above.This medication is to be given as and when required and a call will be made for parental consent on each occasion.

By ticking this box you are digitally signing this Medical Consent FormI understand that the medication listed in this Medical Consent Form must be delivered to school by me or the following mentioned responsible adult.I accept that this is a service that the school is not obliged to undertake and agree to inform Fulston Manor School of any changes to doses or medication immediately.

Please enter the name of the additional responsible adult who is authorised to deliver medication into school on your behalf

In the event of an emergency, we need to know who are the best points of contact for your child. Please provide us with two emergency contact details.

First Family Contact

Full name of first emergency contact* First contact's relationship to student* First contact's primary contact number* First contact's secondary contact number

Secondary Family Contact

Full name of second emergency contact* Second contact's relationship to student* Second contact's primary contact number* Second contact's secondary contact number

Parent/Carer and Student Consent

The following section must be completed by the student.

Student's Full Name*

Please tick to agree to the following statements*I agree with the information and content of this Individual Healthcare Plan.I give my consent for this plan to be shared as appropriate.

The following section must be completed by the parent/carer.

Parent/Carer Full Name*

Please tick to agree to the following statements*I agree with the information and content of this Individual Healthcare Plan.I give my consent for this plan to be shared as appropriate.