Medical Care Plan - John Taylor High School

If your child has a medical condition that requires an Individual Health Care Plan, then please complete the following form, ensuring you include as much information as possible.

Pupil's Name(Required)

First Last

Date of Birth(Required)

Form Tutor

Tutor Group(Required)

Head of Year

GP Name(Required)

GP Telephone Nuumber(Required)

Other Relevant Medical Professional (eg Consultant, Physiotherapist)

Emergency Contact Details

Emergency Contact Name(Required)

1st Contact

Emergency Contact Name

2nd Contact

Emergency Contact Telephone Number(Required)

1st Contact

Emergency Contact Telephone Number

2nd Contact

Emergency Contact Mobile Number(Required)

1st Contact

Emergency Contact Mobile Number

2nd Contact

Emergency Contact Work Telephone Number(Required)

1st Contact

Emergency Contact Work Telephone Number

2nd Contact

Emergency Contact Relationship To Pupil(Required)

1st Contact

Emergency Contact Relationship To Pupil

2nd Contact

Emergency Contact Email Address(Required)

1st Contact

Emergency Contact Email Address

2nd Contact

Emergency Contact Home Address(Required)

1st Contact

Emergency Contact Home Address

2nd Contact

Medical Information

Medical Condition/History(Required)

Is the Medical Condition stable?(Required)

Yes

How does or how could the current medical condition impact on the child's school life?(Required)

Are there any triggers?(Required)

What are the symptoms?(Required)

Physical Management

Toileting(Required)

PE Lessons(Required)

Educational Visits(Required)

Access around school(Required)

Feeding(Required)

Communication(Required)

Transport Arrangements(Required)

Anything else you consider important for the school to be aware of?

Emergency Plan/Protocol

Please give as much detail as possible

Emergency Plan/Protocol(Required)

Medication

Should your child require medication whilst at school, please complete the following section

Is your child able to manage, carry and administer their own medication?

Please indicate your consent for permission for trained staff to administer prescribed and/or non-prescribed medication as provided by yourself, the parent.

Yes

Other

Do you give permission for staff to send this Healthcare plan to medical professionals, should an emergency happen?

Yes

Other