Students requiring emergency action plan(s) and/or medication(s) that need to be given during school hours will need one or more of the following forms completed.
Prior to the beginning of each school year, emergency action plans and medication authorizations should be turned in to your child's school health office and reviewed with your Licensed School Nurse.
This form should be completed for all new students to Rochester Public Schools and those entering kindergarten, 3rd, 6th, and 9th grades.
For questions regarding individualized student health plans, please contact your school health office.
For general health services questions, please connect with our coordinator of health services.
Leah Bancroft, MSN RN LSN PHN NCSN
Coordinator of Health Services
Email Leah Bancroft
To exchange information with an outside agency regarding your child’s emergency action plan(s) or medical condition(s). This form is requested of all children with an emergency action plan(s) or medical condition(s).
This form provides guidelines for your child’s classroom and special area classrooms. ONLY complete for Early Childhood and Elementary Students.
If your child will be eating school meals and requires substitutions due to a food or drink intolerance or allergy, please contact Student Nutrition Services at (507) 328-4250.
For more information on the Special Diet Statement Form and Lactose Intolerance, please visit Student Nutrition Page.
Complete this form if your child needs medication given during school hours. A parent/caregiver's and Prescribing Health Professional's signature are required for prescription medication. More information about medication administration at school can be found under Rochester Public Schools medication policy 516 or by contacting the Licensed School Nurse at your child's school.
Students can carry emergency rescue medications with them (for example, an asthma rescue inhaler) if they have written consent from a parent/caregiver and their Prescribing Health Professional. In addition, the Licensed School Nurse will need to meet with the student to ensure that they can safely and successfully carry their own medicine. Contact your child's Licensed School Nurse for the appropriate form.
Secondary students can carry and administer over-the-counter non-prescription pain relievers (for example, ibuprofen or acetaminophen) if they have written consent from a parent/caregiver. In addition, the Licensed School Nurse will need to meet with the student and ensure that they can safely and successfully carry and administer their own medicine. Contact your child's Licensed School Nurse for the appropriate form.
