Various health forms are used in the Amesbury Public Schools. Using these forms helps assure that children get the care, services and accommodations each student may need during the school day.  The following forms may be completed by a parent/guardian and/or clinician to be submitted to the student's school nurse.

Copies can always be obtained at your designated school nurse's health office.

Should your child require the use of a rescue inhaler during school hours, this Asthma Action Plan should be completed by your child's provider and handed to your designated school nurse.  View the attached Massachusetts Asthma Action Plan. 

MA Asthma Action Plan

A plan that accommodates the child’s needs throughout the school including in the classroom, in the cafeteria, in after-care programs, during school-sponsored activities, and on the school bus.

Allergy Action Plan

The Diabetic Medical Management Plan (DMMP) is a plan of care for the student with diabetes. It is based on an individualized, prescribed plan from both the student's personal health care team and parent/guardian with the specific needs of an individual student in mind.  It should detail all the elements of care and assistance for that student.

Diabetic Medical Management Plan

Amesbury Public Schools encourages families to utilize their own medical care provider for the performance of the physical examinations, whenever possible. A record of that exam should be provided to the school nurse:

1.    Within one year prior to entrance to school or within 30 days after school entry and at intervals of either three or four years thereafter. (grades K, 4, 7 & 10).

2.    Students under 16 and over 14 years of age requesting employment certificates,

3.    Prior to a student’s participation in competitive athletics, on an annual basis.

Note: Parent/Guardians are always welcomed and encouraged to keep the school nurse up to date with annual physicals/immunizations as they change.

MA School Health Record: Health Care Provider's Examination Form

If your child requires medication during school, please visit our Medication Page

A tool that organizes and communicates the student's health care needs.  A seizure action plan helps ensure a safe environment for the student and outlines basic first aid as well as appropriate emergency responses to ensure the child's safety in the event of an acute seizure emergency. 

Seizure Action Plan 

Typically completed at the start of the school year or upon transfer into our schools, this is an emergency form to let your child's school nurse be aware of a student's basic emergent health needs with approval/disapproval for over the counter medications as well as potassium iodide (KI) in the event of a nuclear emergency. This form also provides emergency contact numbers in the event of a health emergency.  On the reverse side of this form are reasons for taking KI along with its associated risks and benefits.

Student Emergency Card